There’s a difference between a doctor and nurse practitioner [Canada] - APPex response

APPex's formal response to Dr. Graham

Dr. Graham:

Thank you for your opinion response here and your advocacy for interdisciplinary collaboration between all healthcare clinicians. We agree that a team-based provider model best "fosters continuity of care, timely appointments, greater access to after-hours care, better coordination of services; and, improved patient health outcomes".

As executive and administrative leaders and experts on the advanced practice provider roles in healthcare (e.g., PAs, NPs, CRNAs, etc.), we would like to respond/clarify some of your statements:

1. "Nurse practitioners are regulated independent health professionals licensed by a regulatory authority. They are authorized to ...within their scope of practice."
   
   So are physicians. In the U.S., NPs are regulated by state boards of nursing, while physicians are regulated by state boards of medicine. All providers must practice within the scope of their training and specialty.
   
   
2. "The education and residency training of family physicians results in knowledge, skills and abilities that differ from nurse practitioners."
   
   This is correct. Family physicians have more formal education via residency training which is not required for NPs. However, this additional schooling has never been associated with improved clinical outcomes for patients or any other patient care/treatment advantages (e.g., better access, better patient education, better patient satisfaction, better patient compliance, less wait times, etc.). Evidence has shown that NPs tend to a) spend more time with patients and b) be better with patient education (likely due to their training as nurses).
   
   
3. "[Physicians] are trained to provide differential diagnosis for conditions that affect all body systems, develop treatment plans that address multiple organ systems and order and interpret tests within the context of the patient's overall health condition."
   
   Nurse practitioners are trained in all of these as well. Implying that the difference in physician training versus NP training is that MDs/DOs are taught these elements of medical care and NPs are not is misleading.
   
   
4. "Family physicians are often consulted by nurse practitioners when a patient presents with complex problems, multiple diagnoses or clinical management challenges."
   
   Other nurse practitioners are also consulted, and many times physicians consult with NPs regarding these challenges. It depends on the healthcare setting and the experience of the provider, not their title. All providers should reach out to their colleagues to ensure the best care for their patients, again, regardless of title.
   
   
5. "Nurse practitioners who work outside a regional health authority are also required to have a formal relationship with a physician for the purpose of consultation."
   
   While this may be the case in your province or in Canada, it is not in the U.S. About half of the states allow complete independent practice by NPs while most others have "limited" independence, usually a similar formal collaboration agreement.

Thank you again for your response. Overall, we found it very positive and focused around a cooperative spirit between the provider roles aimed at enhancing the patient experience. MDs/DOs and NPs working in concert, leveraging the best elements of their backgrounds, training, and experience, will offer the ideal outcomes.

Advanced Practice Provider Executives, Inc. (APPex)
Palo Alto, CA

bit.ly/APPex55