That's how the Philadelphia Business Journal refers to them.
Hmm. That's interesting. It sounds like they are being referenced as equals to physicians. Now they carry their own classification as a specialty. When I think of specialties, I usually think of internists. I think of pediatrics. I think of family medicine. I think of perhaps cardiology, gastroenterology, even general surgery. Maybe orthopaedics. Perhaps neurosurgery.
I'm not sure I would call a nurse practitioner a specialty. I suppose if you get right down to semantics, being a nurse is a specialty. A lab tech is a specialty. An ultra sound technologist is a specialty.
As far as I am aware, there is no board certification for nurse practitioners to specialize in primary care. Just as I am unaware of any board certification for nurse practitioners to specialize in cardiology. The reference to specialty should be limited to those professions that have specialized in their field of practice. I would be more apt to call a nurse a specialist in nursing than I would be to call a nurse practitioner a specialist in primary care.
Perhaps, instead of using the words specialist in primary care, we should limit it to specialist in Minute Clinics.
You see primary care is not Minute Clinics. And Minute Clinics are not primary care. The two are completely in congruent with patient populations, disease states, time constraints and management issues.
The moment Minutes Clinics run by nurse practitioners have, as their normal population 70 year olds with CHF, DMII, CAD, OA, Obesity, HTN, CKD, AF, Coumadin dosing and PVD who show up with vague complaints like dizziness or shortness of breath (COPD dyspnea)is the day that minute clinics become primary care.
Until then, calling them a primary care specialty does a disservice to the seven years of post graduate training and board certification exams required for medical doctors to achieve that title. Just another reason I hate the classification of family medicine and internists and pediatrics as primary care. It has the connotation of simple medicine. A medicine of triage. That is not what it is.
Perhaps bits and pieces, like Minute Clinic care, can be siphoned off at the expense of subsidizing the complicated time consuming medical care of chronic medical conditions. But the fact remains, primary care is difficult. It requires physician level training to practice in whole, to accommodate for vast differences in patient populations and presentations of disease. It requires physician level training for quick and accurate differential diagnosis. It requires physician level training for that long tail diagnosis to be made. The correct terminology for primary care should in fact be specialists in comprehensive care.
By the way, most nurse practitioners I know work in sub specialty medical groups as data gatherers, pager deflectors and efficiency stimulators. They are not primary care specialists as the Philadelphia Business Journal implies. Yet they have the same educational requirements as those that do practice in primary care. Why aren't we calling these nurse practitioners cardiologists? Why aren't we calling them gastroenterologists? Why aren't we calling them Oncologists? They have the same training as their "primary care specialty" trained classmates, classmates who have apparently achieved a rank of specialist in primary care.
If you want to call nurse practitioners who practice in primary care a primary care specialty, then you must also call nurse practitioners who practice in cardiology or gastroenterology cardiologists and gastroenterologists. An assertion that would be struck down without regard for debate.
That's my beef.
Hmm. That's interesting. It sounds like they are being referenced as equals to physicians. Now they carry their own classification as a specialty. When I think of specialties, I usually think of internists. I think of pediatrics. I think of family medicine. I think of perhaps cardiology, gastroenterology, even general surgery. Maybe orthopaedics. Perhaps neurosurgery.
I'm not sure I would call a nurse practitioner a specialty. I suppose if you get right down to semantics, being a nurse is a specialty. A lab tech is a specialty. An ultra sound technologist is a specialty.
As far as I am aware, there is no board certification for nurse practitioners to specialize in primary care. Just as I am unaware of any board certification for nurse practitioners to specialize in cardiology. The reference to specialty should be limited to those professions that have specialized in their field of practice. I would be more apt to call a nurse a specialist in nursing than I would be to call a nurse practitioner a specialist in primary care.
Perhaps, instead of using the words specialist in primary care, we should limit it to specialist in Minute Clinics.
You see primary care is not Minute Clinics. And Minute Clinics are not primary care. The two are completely in congruent with patient populations, disease states, time constraints and management issues.
The moment Minutes Clinics run by nurse practitioners have, as their normal population 70 year olds with CHF, DMII, CAD, OA, Obesity, HTN, CKD, AF, Coumadin dosing and PVD who show up with vague complaints like dizziness or shortness of breath (COPD dyspnea)is the day that minute clinics become primary care.
Until then, calling them a primary care specialty does a disservice to the seven years of post graduate training and board certification exams required for medical doctors to achieve that title. Just another reason I hate the classification of family medicine and internists and pediatrics as primary care. It has the connotation of simple medicine. A medicine of triage. That is not what it is.
Perhaps bits and pieces, like Minute Clinic care, can be siphoned off at the expense of subsidizing the complicated time consuming medical care of chronic medical conditions. But the fact remains, primary care is difficult. It requires physician level training to practice in whole, to accommodate for vast differences in patient populations and presentations of disease. It requires physician level training for quick and accurate differential diagnosis. It requires physician level training for that long tail diagnosis to be made. The correct terminology for primary care should in fact be specialists in comprehensive care.
By the way, most nurse practitioners I know work in sub specialty medical groups as data gatherers, pager deflectors and efficiency stimulators. They are not primary care specialists as the Philadelphia Business Journal implies. Yet they have the same educational requirements as those that do practice in primary care. Why aren't we calling these nurse practitioners cardiologists? Why aren't we calling them gastroenterologists? Why aren't we calling them Oncologists? They have the same training as their "primary care specialty" trained classmates, classmates who have apparently achieved a rank of specialist in primary care.
If you want to call nurse practitioners who practice in primary care a primary care specialty, then you must also call nurse practitioners who practice in cardiology or gastroenterology cardiologists and gastroenterologists. An assertion that would be struck down without regard for debate.
That's my beef.
Absolutely right on! How much further can we go to denigrate primary care and make it the most unappealing place in Medicine?
ReplyDeleteNot necessarily disagreeing with the content of your post, however, NP's in NE are required to be board certified in their specialty (the American Nurses Credentialing Center is the main certifying body). The specialties are not designated as cardiology, gastroenterology, etc, but as "acute adult," "adult," "family," "psych," and "pediatric."
ReplyDelete"The moment Minutes Clinics run by nurse practitioners have, as their normal population 70 year olds with CHF, DMII, CAD, OA, Obesity, HTN, CKD, AF, Coumadin management and PVD who show up with vague complaints like dizziness or shortness of breath is the day that minute clinics become primary care."
ReplyDeleteI am working in a primary office with the exact above criteria. By your definition, I would be considered a primary specialist, but I actually agree with your view of nurse practitioners not being primary specialists.
I don't consider family medicine a specialty because it encompasses many different facets of medicine. A specialty by definition is focused on one area of medicine. As a nurse, I didn't agree that Med/Surg is a specialty either and that probably made a few people upset.
Regardless, I do think that NPs will evolve into complete primary care providers due to the decrease in primary care physicians.
I understand MDs angst at NPs doing the same jobs with less schooling. I wouldn't be happy if a BSN nurse started being able to diagnose and treat patients like I do without having to complete the same educational standards.
What to do about it? Nothing can be. We just hope that all medical providers regardless of education know what the hell they are doing.
There are some who don't and they have almost killed a few of my patients already. There are bad docs and bad NPs.