<p>What are some of the key practical diferences between the work routines of physicians and advanced practice nurses? For example, in what ways would the practices of nurse practitioners and family medicine doctors differ? How about certified registered nurse anesthetists and anesthesiologists? Besides paygrade and prestige...</p>
<p>B.u.m.p. …</p>
<p>Depends on the state as to how much “independence” NPs have; they do have prescriptive authority in all 50 states. Some states allow NPs to practice completely independently, whereas some have to have MD supervision (that doesn’t mean they can’t see their own patients, it just means that they have to have a contract with an MD and occasional reviews of charts). Family med is probably an area in which NPs would have more free rein than in other fields.</p>
<p>I can only speak to North Carolina, but the NPs I worked with in family med and peds had their own patient schedule, ordered labs and imaging, made referrals, and generally managed their own patients for the most part.</p>
<p>Thank you - that’s exactly the kind of information I was looking for.</p>
<p>Would you say there’s any real quantifiable difference in patient contact/paperwork time distribution? Or in regular work schedule?</p>
<p>The NPs I worked with, especially the one in family med, tended to spend a little more time with their patients, and therefore had less patients on their schedule for the day. The family med one would schedule physical appointments for 30 minutes whereas some of the MDs had these as 15 minute slots (or had 30 minute slots but never used the whole time with the patient). I don’t think it’s because they’re “slow” or anything - I think it’s because they choose to spend more time interviewing the patient and doing counseling than the MDs do. This may be a factor of them being educated on the “nursing model” vs. the “medical model.” There might be slightly less paperwork - where I worked, the MDs were doing nursing home referrals and paperwork and ADD evaluations whereas the NPs didn’t.</p>
<p>However, when on “sick” office call, the NPs were very efficient and productive and could see similar numbers of patients as the MDs.</p>
<p>(Keep in mind that what I’ve observed is a small sample size, so I don’t know if everything I’ve written is universally true about NPs.)</p>
<p>In every situation I’ve worked with NP’s and PA’s, the big difference is ultimate responsibility. Every single NP and PA I’ve had the pleasure of working with has had patients and situations in which they had to come to the MD for assistance. Much of the times, it’s a training thing, however at times there are legal reasons for this - in some states NP’s can’t prescribe certain medications, or there are certification issues, Pediatric APN’s (those with specific certification in pediatrics), their training only certifies them to taking care of patients to age 18. They had to have an MD supervise them directly and sign their hospital orders for them…even if it was just a resident physician.</p>
<p>In academic settings, NP’s and PA’s will most often be treated as on the same level as interns, even if they have years of experience. </p>
<p>One other major difference is the ability to do procedures. There may be limitations on doing invasive procedures for NP’s. As a pediatrics resident, I see this most often for things like sutures and lumbar punctures. For CRNA’s, this might be limitations in things like prescribing Patient Controlled Analgesia Pumps, certain types of nerve block procedures, or nasal intubations. </p>
<p>In my mind the biggest difference between NP’s and PA’s, is freedom. NP’s have to start off and decide early on if they want to be pediatric, neonatal, or family practice. PA’s have much more flexibility of changing specialties without additional training or certification. </p>
<p>For MD’s vs midlevel practioners, it’s one of expertise, training, and responsibility. MD’s will be at the top of the totem pole no matter the situation.</p>
<p>Full disclosure: I am a PA student. To me, it came down to PA vs. MD/DO route (I didn’t consider NP because I almost had my college degree finished and didn’t want to spend time getting a BSN, then doing a NP degree). I chose not to do MD because I probably would be in my mid 30s before I’d be able to start practicing, and I really like the flexibility of changing specialties that PAs get.</p>
<p>I did see our NPs and PAs consulting with the MDs sometimes to get certain situations resolved or help with patients, but it was not really that big of a deal to me…after all, I saw our MDs consulting with each other frequently as well and even going to see patients together (even our senior pediatrician who has been practicing for 35 years). For PAs, anyway, a lot of learning is done on the job because so much less time is spent in school, so consulting with MDs who are more experienced is part of the learning process.</p>
<p>As far as the hierarchy goes, I would agree that midlevels are probably on the level as an intern, and MDs always will be “top dog.” Again, this does not really bother me because a) I know my training =/= MD training and I’m OK with knowing my limits, and b) I really can only see myself working in an outpatient setting, not an academic setting. If the prestige or “hierarchy” would bother you, then you might just want to go for the MD.</p>
<p>PAs can do a year-long residency program if they so desire after graduating from an accredited program, but it is not required…if you know you absolutely want to do emergency med, ortho, etc. the residency will teach you additional procedures and get you more comfortable with the specialty, giving you less that you’ll have to learn on that first job and more leverage to negotiate for a higher salary.</p>
<p>I’m an NP, certified in Adult Nursing and I practice in a sub-specialty. I am not a doctor, nor do I want to be a doctor. I am very well aware of what my limitations are. Some of the limitations are by state law of what I can and cannot do and some of the limitations are based on my own experience level. </p>
<p>I work in a “collaborative” state which means that I have to have an MD that will collaborate with me. I am not supervised. I can write my own scripts and I have full prescriptive authority and have a DEA license. By law, the MD can override any of my decisions. I do not have to have anything co-signed by a doctor. </p>
<p>I work in both the hospital and office. In the hospital I do rounds, often by myself,and then sign out to the attending. If there is someone I am concerned about, I may have the doc see the patient too. Sometimes we just talk together over a plan of care. I even do consults. </p>
<p>In the office, I have my own schedule. I see patients in 15 or 30 minute slots depending upon what they are they for. I give more time to emergency visits, post hospital visits and pre-op clearances. The patients do not see the doctor, they just see me. I average about 18-20 patients a day. That is on top of taking care of triage phone calls,abnormal labs, etc… </p>
<p>I consult with the doctors when I need to. As I became more experienced and the doctors became more comfortable with my decisions, I needed to talk to them less frequently. I learn quite a bit talking to them and I have no hesitation going to them with questions. I am in a large practice with many doctors and several mid levels. Someone is always consulting with someone and the doctors talk to each other all the time about different cases. </p>
<p>I agree about the hierarchy. I function as a resident. In my sub speciality, there is no need for me to do any procedures. But I have many friends that do procedures such as insert central lines and do lumbar punctures. </p>
<p>As far as paperwork? I probably see more than the doctors do. They hate paperwork and that tends to get dumped onto the mid-levels. </p>
<p>My hours are better than the doctors. I am not on call although I know many that do take evening call. I don’t work the typical 8 hour day. It is not unusual to work 10 hours, sometimes 12. I work weekends too. </p>
<p>And as for pay? Laugh, laugh. Definitely not the same nor near the same as the doctors. I get paid well but I would hate to break it down into an hourly rate. Experienced RN’s get paid more by the hour than I do. </p>
<p>I love my job though. I love being an NP. I can’t imagine doing anything else.</p>