Physicians Should Pilot Patient Care, Not Nurse Practitioners

April 9, 2014
Mary Christ, MD, MBA

Physician Mary Christ expresses skepticism about the expanding roles for nurse practitioners.

When CVS recently announced its intention to cease selling tobacco products, little attention was paid to the company's strategic plan to expand urgent care centers in its stores. At a time when Obamacare is predicted to create an onslaught of urgent-care patients, CVS's maneuver could prove to be a brilliant solution to the dearth of physicians by filling the gap with nurse practitioners (NPs). Or, maybe not.

As NPs continue to expand their numbers and scope of practice, physicians have expressed concern about having to compete for patients. Although competition and loss of income are troubling to some physicians, perhaps the focus should be on quality of care and patient outcomes as NPs continue to usurp traditional physician roles.

Consider the fact that a NP can earn a license with less than four years of college via accelerated programs; allowing persons with associate degrees to obtain master's degrees in as few as 18 months. Alarmingly, NP programs require at most 650 hours of clinical work, with NP students often left to their own devices to arrange their clinical rotations in a "catch-as-catch-can" fashion. Moreover, NPs are not required to take cadaver gross anatomy, and have only cursory training in organ system diseases and processes.

In contrast, a physician must have at least a bachelor's degree prior to attending four years of medical school, followed by at least three years of residency and often several years of fellowship. In terms of hands-on clinical hours, the average physician undertakes an estimated staggering 25,000 hours of training.

With physicians having more than 40 times the clinical preparation than a NP, as well as in-depth knowledge of the pathophysiology and disease processes of every organ system, it is mind boggling how NPs have been allowed to rapidly and insidiously assume the role of primary-care physician (PCP).

Given the seemingly desperate call for PCPs, have standards been sacrificed to meet demand? And, what are the effects of allowing NPs to act as surrogate PCPs - especially when NPs are allowed to function autonomously in many states? Certainly, there is a role for NPs as complementary - not replacement physician - caregivers, and the proper oversight and regulation must be instituted to oversee these roles.

As an analogy, would you fly on a plane piloted by flight attendants who, due to cost-cutting measures, were replacing pilots? They do, after all, know "something" about the plane and have finely-honed interpersonal skills.

Time will tell if CVS's "Diagnoses While You Shop" centers ultimately improve or harm the health of our patients. But, given the lack of regulation and outcomes assessments, this patient will stick with her physician and only fly in planes with pilots at the helms.

Mary Christ, MD, MBA, is former technology executive who attended medical school to merge her passions of computer engineering and medical science. She is a freelance healthcare IT physician executive consultant. Do you feel that nurse practitioners should only complement, not replace, physicians? Tell us at editor@physicianspractice.com. Unless you say otherwise, we'll assume that we're free to publish your comments in print and online.

This article originally appeared in the April 2014 issue of Physicians Practice.