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When NPs Have the Advantage Over Doctors (And Vice Versa)

Op-Med is a collection of original articles contributed by Doximity members.

My role as an NP gives me one distinct advantage as I provide care for my patients: First and foremost, I am, and will always be, a nurse. Yes, I have two advanced degrees, one a Masters and the other a Doctorate. What does that make me? An experienced, well-educated professional, with a heart and foundation in nursing. Why should that matter to my patients? For many reasons. Oh, let me count the ways. 

When asked, I tell people I’ve lived nine lives in nursing. I started out as a patient care technician while I was an undergrad, where I worked hard to figure out how to move patients safely and without hurting myself, and how to stand the smell of urine and poop and everyone’s absolute least favorite bodily secretion: spit. Honestly, many nurses will say the same. Something about changing trachs and having mucus spewed at you just makes you dislike the slimy stuff. I took that job to learn about patients and how to take care of them at a very basic level. It is just like the old poem about how everything I needed to know, I learned in kindergarten. I learned to listen to patients and find out what concerned them and how to make them comfortable, both physically and emotionally. And most importantly of all, I learned how to be comfortable around sick people. That provided me with lessons that have spanned decades.

The rest of my nine nursing lives included labor and delivery, pediatric neurology, pediatric surgery, and orthopaedics, being a school nurse, an early intervention nurse, an IV team nurse and manager, pediatric HIV care, radiation oncology, and finally, I landed in my basecamp of medical oncology. I am only a highly competent NP today because my combined nursing experiences made me competent. I remember telling a surgeon that he should not send a postop child home that had an appy because the incision did not look right to me. I thought it looked edematous. The resident had just examined the child and was unimpressed. I argued with the attending until he examined the child himself. He looked at me, then at the resident, then at the child and said the incision needed to be re-opened. The purulent exudate from that incision shot across the exam room like a geyser when the incision was opened. My nursing eyes had examined the child carefully to make that assessment. The resident did not see it. I am not bashing that resident. He was being pushed to discharge patients. I am just saying that my assessment skills as a nurse were vital to that child’s well-being. Those skills were developed over time. Those same assessment skills enable me to make highly targeted decisions for my oncology patients today. 

My foundations in patient care are grounded with holistic roots. That is the focus and foundation of care provided by a nurse practitioner. One of the first things I learned in graduate school was the concept of considering the whole person when providing care. You cannot treat just the injured foot. You need to figure out why the 75-year-old man fell and injured that foot and determine your role in helping to prevent the next injury. Sometimes that means calling his family member, or inspecting his shoes, or finding a social worker, or asking if he has had an eye exam in the last five years. As nurses, we look at all the parts that make up the whole, for holistic care. We nurses are really good at that.

I know there are many people who still lack the confidence in care provided by an NP and instead choose a physician. That is absolutely their prerogative. Although this may not be popular with some of my NP colleagues, there are some medical cases that I feel should be in the hands of a doctor. I have worked with many highly competent NPs but I do believe that in some complex situations, the doctors have an advantage. Their training provides a vantage point from which to consider and formulate the very complex diagnoses. I am not saying that an NP cannot, but I am saying doctors have the better groundwork foundation for it. They study disease at a depth I did not touch in graduate or undergraduate education. Doctors are excellent diagnosticians. We expect them to be. They study diseases that I never heard of in school. They take Step 1, 2, and 3 and hit all the minutia along the way that tests their education. As NPs, we do not. If I have a rare illness and no one can figure it out, send me to a doctor, please.

The role of the NP was not originally designed to replace an MD, but rather to provide collaborative care. The American Academy of Nurse Practitioners states that the first training program was developed as a collaboration between Loretta Ford and Dr. Henry Silver as a way to address the lack of adequate primary care services. That was in the 1960s, last century. The NP role grew out of the MD shortage. As the role has morphed over the years, the role is still growing because of a looming MD shortage in the next 20 years and increasing numbers of patients who need care. As medical, nursing, and patient care are progressing, so is the role of the NP. Yes, an NP can replace a doctor’s care in some ways, but not totally. 

MDs and NPs have different basic education and training. The vast majority of NPs spent several years first working as an RN before moving to an advanced degree. Years of patient care provide valuable knowledge at every level of care. Many physicians have their first limited experience in patient care in the later part of medical school and only briefly. It is not until they are residents, well after they have earned the title of MD, that they have any significant patient care experience. They are put on hospital wards, armed with their vast book learning, and given patient assignments in July of their first year of residency without the sufficient care time to bolster them forward. They rapidly acclimate and progress but on a much different care continuum than nurses do.

So, MD care versus NP care? I’m not sure we really need to compare. Instead, we should understand that both are necessary in this very complex world of patient care today. Giving patients the exposure to both MDs and NPs provides them options that can provide easier access and well-rounded care. 

Dr. Karen Scanlon Henry is a nurse practitioner in medical oncology in Miami, Florida. She enjoys baking, long walks, reading, and philosophical discussions with her adult children. Writing has been a lifelong passion and hobby for her. Karen was a 2022–2023 Doximity Op-Med Fellow.

Illustration by April Brust

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