NPs Continue to Be Under the Physician Microscope

Abstract

One of my colleagues sent me an article recently from the Journal for Clinical Epidemiology. In it, a familiar title caught my eye: “A Landmark Randomized Health Care Trial: The Burlington Trial of the Nurse Practitioner.”1Sackett DL A landmark randomized health care trial: the Burlington trial of the nurse practitioner.J Clin Epidemiol. 2009; 62: 567-570Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Another article by a similar title was published in 1974 in the New England Journal of Medicine by Walter O. Spitzer just as the nurse practitioner (NP) role was expanding in the United States. Spitzer was a leader in outcomes research; this was one of the first NP outcome studies published and certainly one of the most methodologically rigorous. Spitzer continued to be an international leader in evaluation research for many years and was part of the strong physician research group associated with McMaster University in Canada. The new article revisited the earlier landmark research on the NP role and restated the findings about care provided by physicians and NPs, “Both groups of patients had a similar mortality experience, and no differences were found in physical functional capacity, social function, or emotional function. The quality of care rendered to the two groups seemed similar, as assessed by a quantitative ‘indicator-condition’ approach. Satisfaction was high among both patients and professional personnel.” The researchers could not conclude in their original study whether there was a financial benefit to using an NP; the role was so new that there was no provision in the health care system to pay NPs. This problem has only been partially rectified over time. However, the other findings about the generally high quality of care have been constant in numerous published research studies since 1974. Over the past 45 years, no research studies have found NPs to be dangerous, ill-prepared, careless, or providing risky or second-class care. Thus, NPs continue to be both stunned and outraged by release of such materials as the recently updated 142-page American Medical Association Scope of Practice Partnership document,2American Medical Association Scope of practice series: nurse practitioners. American Medical Association, Chicago2009Google Scholar released October 2009 and marked as a “resource compendium for state medical associations and national specialty medical societies.” This document purports to summarize information about the educational preparation, practice, and research findings about NPs. A review of this document reveals many inaccuracies, omissions, and a negative bias in presentation. Earlier releases of this report indicated it provided information to help physicians fight legislation introduced by NPs and “win back” turf lost to nonphysician providers over time. Our physician colleagues with whom we practice are often our biggest allies. However, organized medicine needs to stop fighting NPs. There are certainly more than enough patients for all provider groups. Physician groups need to stop suggesting that NPs provide inferior care or overstep our legal scope of practice. They should spend more time improving the quality of care, competency, and compassion in their own practice and stop trying to control NP practice.