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Do Doctors Fear Nurse Practitioners?

Two states consider either modifying doctor oversight for nurse practitioners or getting rid of the oversight requirement altogether. Both Nebraska and South Carolina have seen an increase of nurse practitioners striking out on their own in recent years, mostly because of an abundance of rural areas. Due to increased workload and less pay, doctors tend to flee rural areas, and nurse practitioners have filled the void.

“Nurse practitioners can perform about 80% of what a medical doctor can do” is a common idiom for nursing students. We won’t go into detail about these differences here, but needless to say you won’t go to a nurse practitioner for surgery, and yet the same could be said of a family medicine doctor, which is the type of doctor many of these nurse practitioners in rural areas are replacing. So can we say that rural area patients that see nurse practitioners receive lesser care?

Even though they may sound and look the same to patients, nurse practitioners, primary care physicians, and family medicine doctors are different and everyone needs oversight when they hold lives in their hands. Nebraska and South Carolina understand this. Their biggest issues with oversight requirements derive from how these requirements are met. Here are the details, starting with the state that wants to get modify these requirements, South Carolina.

South Carolina

Many South Carolinians can’t get to a primary care doctor because there aren’t enough physicians and nurse practitioners can help fill this gap. Currently, South Carolina has an oversight program that requires a nurse practitioner to sign an agreement with a consulting physician within 45 miles of their location and that physicians may only consult with up to three advanced-practice registered nurses in any shift. Nurses support House Bill 3078 that eliminates the mileage requirement and the ratio of nurse practitioners a physician can oversee.

Doctors oppose this bill. First, they don’t want to drive all over the state in order to see patients. Second, with having no ratio of nurse practitioners, they’ll be responsible for the lives of more patients and that could cost them dearly. So the Medical Association drafted another bill, House Bill 3508, to combat the nurses’ bill. House Bill 3508 will increase the 45-mile restriction to 60 miles and double the ratio to six advanced-practice nurses under their charge.

The two sides continue to battle it out. Hopefully, they’ll reach a compromise, but what happens when a state wants to get rid of the oversight program all together?

Nebraska

Despite western Nebraska being as rural as you can get with no medical doctors in hundreds of miles, Nebraska’s biggest issue with their nurse practitioner oversight program rests with the annual fee. Nurse practitioners have taken the jobs medical doctors don’t want—because of long hours, a heap of patients every day, and less pay—and they get charged $5000 a year for doing so. You can see why some folks believe medical doctors should pay nurse practitioners not charge them.

But this fee serves a purpose. Whenever a doctor oversees a nurse practitioner, they add the nurse practitioner to their insurance. If the nurse practitioner does anything negligent, it falls on the medical doctor. With Nebraska getting rid of this requirement, who pays for the liability insurance? Nurse practitioners may have to pay for their own insurance.

Nebraska senators voted 35-2 to advance Legislative Bill 107, the one to eliminate the nurse practitioner’s need for oversight, to the second of three rounds of consideration. The bill also will require nurse practitioners to get 2,000 hours of clinical practice under the guidance of a doctor or established nurse practitioner before they could practice independently.

This impending bill has led to a heated dispute between doctors and nurses. Members of the Nebraska Medical Association (NMA) claim that doctors have more years of education and clinical training than nurse practitioners, who have masters or doctoral degrees in nursing.

Legislative Bill 107 reduces the gap in clinical training between nurse practitioners and medical doctors. But do nurse practitioners have less education than doctors?

NP versus MD

Nurses can have associates degrees all the way up to doctorates. Until recently, there were nurses with one-year diplomas. This education disparity has led to a lot of confusion, even within the medical community.

A nurse practitioner with a doctorate does have a similar level of education as a medical doctor, so the NMA is wrong with their assessment. But nurse practitioners with master’s degrees don’t have as much education as medical doctors, and they’re still called nurse practitioners, so the NMA is right in that regard. A medical doctor always has the same amount of education and clinical hours when they go independent.

The landscape of the medical profession is changing but perhaps, the nursing profession should change more with it. Everyone in the nursing profession can be called a nurse just like everyone in the Navy can be called a sailor. But not every member of the Navy is an admiral.

If every nurse practitioner holds a doctorate and receives the same number of clinical hours as a medical doctor, then the title nurse practitioner could gain the respect it needs.

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