Nurse Practitioners & Physicians in Primary Care: A Dynamic Duo

Dr. Melissa DeCapua, DNP, PMHNP-BC

Both nurse practitioners and physicians provide high-quality, expert primary care services to patients across the United States. Day to day, they work together for the betterment of their patients; however, sometimes hidden agendas from large political groups can create an uncomfortable and unnecessary rift between this dynamic duo.

Nurse practitioners and physicians each undergoes extensive, specialized education in family medicine in order to diagnose and treat acute and chronic illness. Their care philosophies are intertwined, both including health promotion, disease prevention, and patient education. They often serve as the patient’s first encounter with a healthcare system, determining the patient’s degree of satisfaction and loyalty to a particular hospital.

In the trenches of patient care, these two types of primary care providers collaborate, support each other, and solve problems. They respect and value each other. Sometimes they start practices together, sometimes one employs the other, and sometimes they work independently. They both advocate for patient’s rights, provide cost-effective services and believe that it takes teamwork to ensure the best treatment outcomes.

Conflict seems to emerge on the national level between groups battling over scope of practice policies. The American Association of Family Physicians (AAFP), for example, asserts their belief that nurse practitioners are not independent providers: “The nurse practitioner should only function… under the direction and responsible supervision of a practicing, licensed physician.” These large, physician-led organizations often claim that nurse practitioners have less formal education and, therefore, compromise their patient’s safety.

The American Association of Nurse Practitioners strongly disagrees with the AAFP: “As licensed, independent clinicians, nurse practitioners practice autonomously and in coordination with healthcare professionals and other individuals.” Today, 21 states and Washington D.C. have passed legislation that allows nurse practitioners to assess, diagnose, and treat patients without mandated supervision from physicians.

Since the advent of the nurse practitioner profession, research has investigated the quality, safety, and cost-effectiveness of their patient care. In December 1986, the United States Office of Technology Assessment compared the outcomes of patients who received care from either a nurse practitioner or physician. This groundbreaking study found that nurse practitioners performed as well as physicians in all areas of primary care delivery.

Since then, study after study has reached similar conclusions. A systematic review published in 2011 demonstrated that nurse practitioners in all medical specialties including primary care offer effective, high-quality patient care with outcomes similar or superior to physicians. Other studies have found that nurse practitioners actually lower healthcare costs, increase patient satisfaction, and offer a solution to the current and ever-worsening shortage of qualified primary care providers.

Entities outside the nurse practitioner and physician professional organizations have investigated this turf battle and asserted their opinions as well. In their seminal report The Future of Nursing, the Institute of Medicine assessed the available evidence and determined that states across the nation should remove all legal barriers preventing nurse practitioners from practicing independently.

In early 2014, the United States Federal Trade Commission came forward with another unprecedented publication. Their paper titled Competition and the Regulation of Advanced Practice Nurses declared that laws requiring physicians to oversee nurse practitioners unfairly prevent market competition, raise prices, and diminish access to care.

Despite turf wars and legal battles at the state and national level, nurse practitioners and physicians work collaboratively and respectfully at the patient-level. As a team, they continue to improve the health and well-being of all people and solve the major challenges facing modern medicine. These two types of primary care providers uphold the same Hippocratic Oath, first do no harm, and they both strive to offer high-quality, compassionate care to their patients.

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