Dr. Keith Ablow, a psychiatrist on Fox news, has posted on his blog the worst diatribe I have read in a long time. Read it here: http://health.blogs.foxnews.com/2010/04/15/nurses-masquerading-as-doctors/
Okay, here is my response. I will do my best to keep it civil. Paragraph by paragraph.
First of all, we will see what is in the future regarding the health care reform, but there is, and has been, a shortage of primary care physicians, especially in poor or rural areas. Patients all over America and many other countries have long received primary care from Nurse Practitioners (NPs) who worked independently, or in collaboration with a physician, depending on the state in which the NP has her license and where they choose to work. This is nothing new. Many studies on the effectiveness, safety and patient satisfaction with NP care point to equal or better outcomes than physician care (I have the references if anyone wants them) in the specialities that the NPs practice in: pediatrics, family practice, adult, and geriatric, to name a few. NPs can and do provide excellent primary and specialized care.
The education includes pharmacotherapeutics, and have completed the requisite hours in order to be able to prescribe safely, and have the same CEU requirements as physicians. Each state has their own laws regarding NP prescriptive privileges, but NPs write prescriptions in all states. Only 2 states do not allow NPs to prescribe controlled drugs such as cough medication, certain anti-diarrheals and pain medication. I, unfortunately live in one of them, Florida. Sixteen times a bill has been introduced and sixteen times shot down through the machinations of Florida Medical Association lobbyists, in spite of documented proof that NPs prescribe safely.
As to the right to be called “Doctor”. Doctor is an honorific for someone who has reached a doctorate level of education in any field, Dr. Ablow confuses this with the role of physician. But to answer his objection, NPs don’t generally want to be called doctor, even if they have the Doctor of Nursing Practice degree (DNP). When I get it, I will still introduce myself by my name and title of Nurse Practitioner. In 2015, DNP will be the entry-level degree for nurse practitioner certification, and physicians will have to stop being so touchy about it, we are all there for the patients. It isn’t about ego trips, or shouldn’t be. The minimum degree now is Master in Science of Nursing (MSN).
Obama care is an unknown entity so far, so calling it two-tiered care is just silly. I see no requirements that “poor” people can only see NPs and “rich” people get a “real” doctor. NPs are a resource for good primary care in a time of shortage of primary care MDs, and a great adjunct in the health care team as a whole. Many patients prefer the NP so money is not the issue. NPs are not trying to replace MDs.
Yes, medical school is rigorous and academically challenging, but so is nursing school. Getting into nursing school is tough, many schools have waiting lists of over two years. The average NP has had many years of education to get to where they are. I myself started as an EMT, then got a Nursing Diploma (3 years with many, many clinical hours), then got a BSN, (3 years with more clinical), now I am enrolled in a MSN-FNP program (3 more years and 700 hours of clinical time). All in all, I will have spent 10 years in school, and have 20 years of hands-on experience in nursing. I have worked in hospitals, home health, hospice and case management. I was top of my class every time I went to school, and have a 4.0 right now (and it was not easy!) I suspect most nurses who go the extra time and effort to be NPs are intelligent, hard-working, and driven to help patients. As to physicians having more “raw intellect” than the average nurse – aren’t we a tad arrogant, Dr. Ablow? I’ll match my IQ to yours any day and blow you out of the water.
What you are saying isn’t unpopular, it is untruthful in its insinuations. Suggesting nurse anesthetists (and advanced practice nurses in genreral) are second-rate is out-and-out ridiculous. Many rural hospitals don’t have anesthesiologists available, and would not be able to provide surgical and anesthesia services without CRNAs. Besides, anyone who works in the ER wears a mask and gown “just like the surgeon”, they aren’t hiding or masquerading, just doing their job, you moron. (Oops, sorry, not civil. Will be good…) You pay for anesthesia that is safe, and you get it. It is not relevant whether the one doing it is a nurse anesthetist or an anesthesiologist, they are both credentialed, licensed, and able to do the job equally well.
Also, please differentiate between nurses. I wouldn’t want a psychiatrist to decide if I had pneumonia or the flu, but I sure as hell would place myself in the capable hands of an NP. LPNs and RNs can’t do what you describe, but NPs can and do, and do it well.
- “How come no one in Congress would be able to tell you a story about that incredible nurse who diagnosed the rare condition in his or her child?” Because the idiots in Congress only listen to the lobbyists who give them lots of money, i.e. the AMA (which only represents 25% of physicians, by the way).
- ” How come nurses either failed to be admitted to medical school or didn’t try? ” Because they wanted to be nurses. Nurses are closer to patients (in general, there are always exceptions to the rule, my own MD is a good example), see them as whole people and not just a disease . I was working in the ER and was given D/C instructions for a patient after being seen by the medical person for hematemesis (bloody vomiting). The instructions consisted of a script for a PPI and a referral to a gastroenterologist. When I went in to discharge the patient, I saw he had fresh surgical scars on his wrists. I asked him about them and he explained he had carpal tunnel surgery three months ago. On questioning, it turns out he had been taking Motrin four times a day ever since. “The doctor didn’t tell me not to.” Further questioning of this 20 year-old determined he binge drank every weekend. The medical person never asked. This situation wasn’t even rare or unusual and he didn’t catch it. In this case we needed to know the cause to be able to treat the problem and prevent reoccurrence, this is where NPs shine because of being a nurse.
- “You think it’s because they thought nursing school would train them better to take care of patients? C’mon. It’s because nursing school is easier–as in, 10 times easier.” Since you never went to nursing school, you wouldn’t know, would you? Don’t make assumptions about things you know nothing about. Nursing school is difficult, maybe not as crazy as medical school, but that does not make it less valuable. We go to nursing school because we like the nursing model of health care. We are advanced practice nurses, not mini-doctors.
Nurses don’t impersonate doctors (oops, physicians), they are their own entity; complimentary to physicians, not replacements.
Now a word to Dr. Ablow: Do you feel threatened by NPs? What makes you so hostile? You are supposed to be a healer of the mind and emotional difficulties, yet you seem beset by your own insecurities to lash out so. Perhaps you need a consultation with a psychiatric nurse practitioner, they are well-known for their good listening skills, understanding and compassion.
Okay, I was fairly civil, for a Viking…Sigh, I hate it when I get mad, it never feels good afterwards.