NP vs MD?

[penk]

Edited at 8:34 Changed 'Phd' to MD. Sorry bout that.

For reasons that I don't need to go into right now (but I"ll letcha all know soon), I needed to quickly see a doctor. My PCP at acton medical was unavailable, but I asked if there was someone available I could see immediately. The office person scheduled me with a nurse practitioner, who I saw an hour and a half later.

I was... very impressed. Professional, communicative, knowledgable, friendly... we worked through a whole slew of symptoms and background history and narrowed down to what we're pretty sure the problem is. Lab work is in progress, and she's keeping me informed on the phone as things get discovered and discarded.

This is far better service than I get from my PCP, who has been unavailable (or has had very long lead times) previously. If I had my druthers, I'd much rather see this NP rather than my PCP whenever possible.

My question is - is this the right path? I read a bunch about NP's, and it seems they're as certified, trained, and licensed as your standard MD, but without the MD label. Am I right?

My gut feel is that this person is just as knowledgeable as your average young doctor (she was youngish, but not "omg, you have no experience" young), though she may lack some of the extensive education a MD would have, but for things like this first line evaluation, diagnosis, and recommendation of further tests if warranted - she has all the experience I need. I also feel that if she's unsure about something, she would handily refer to so someone more senior to find out more details. I worry that my american-bred brain is saying "NOT A DOCTOR! GET THE REAL THING!" - but I suspect that's not really appropriate...

Am I right here? Suggestions? I'll happily refer more people to her... she's pretty awesome so far.

(Also, how do I refer to her? nurse x? NP X? :)

Comments

[surrealestate.livejournal.com]

I am confused by your use of PhD here. Did you mean MD? Or are you talking about something completely different that I'm not following?

[keyne.livejournal.com]

Me too. Most physicians are MDs or DOs, and generally have clinical training, not research backgrounds.

[surrealestate.livejournal.com]

Indeed. Though there are also a variety of medical PhDs, and if the issue was psych, for example, the likelihood of seeing one is pretty high.

My personal experience with NPs is very positive. (With one NP in particular, of course, but even in general. :)

But if you want to talk about the differences from the inside, talk to Derek, who is an NP in primary care and was PCP to some hundreds of people at the job he just left.

[penk.livejournal.com]

Aha! I shall do so - likely at Arisia :)

[surrealestate.livejournal.com]

Well, I pointed him at this post. See below. :)

[penk.livejournal.com]

Sorry, edited!

[jacflash.livejournal.com]

keyne is a big fan of one of the NPs at Acton Medical. I don't know if there's some special process for seeing one regularly, but she would.

[keyne.livejournal.com]

Yes, I use Alex Weld whenever possible, even though I adore my PCP (Amy Churchill) -- Alex is wonderful to work with and I can usually get appointments with her much quicker. (Scheduling a physical, for example: 2-3 months out with Amy; 2-3 days out with Alex.)

I've been seeing NPs for years -- at the U of C I much preferred my FNP, who did gynecological and other care, to any of the MDs, who clearly didn't want to be working for a student health service!

[dancingwolfgrrl.livejournal.com]

I specifically love Alex Weld also, and would never hesitate to see her instead of an M.D. I also believe strongly in specialists over generalists for weird problems, and AMA specifically is really good about referring me out. So it doesn't worry me, for what that's worth.

[penk.livejournal.com]

I just looked up the NP I saw:
http://www.actonmedical.com/np_hill.htm

Amy Hill. I can totally recommend here :)

[ghislaine.livejournal.com]

Yes, you're right. Very qualified, often very committed to primary care, and directly supervised by an MD.

Glad you had a good experience today! I'd say stick with her.

(But, um, sorry something's not right w/ your body that caused you to need her service so urgently. Feel better.)

[penk.livejournal.com]

We seem to be on the right path... I'll know in 3 days if we're absolutely on the right path, but we've already started treatment (we're 90% sure the diagnosis she came up with is right, we're waiting for final lab tests to validate it, but at th emoment there's no real harm in starting treatment early).

One data point

[metahacker.livejournal.com]

NPs tend to be some of the more awesome/useful people I interact with in the health care system.

[keyne.livejournal.com]

Oh, and you'd refer to her as Ms. So-and-So. :-)

[penk.livejournal.com]

THANK ou. That was really confusing to me. :) (BTW, I looked at her profile, she doesn't list a PhD, and she's listed as spending time with her husband, so I guess "Mrs Hill" is apropos. Or, if I see her again, I'll ask :)

[keyne.livejournal.com]

It's 2010 now. You really don't want to default to "Mrs." in a professional context unless you're in elementary school :}

[wotw]

My experience with NPs has been extremely positive --- as far as I can tell. But of course I'm quite incompetent to know for sure.

[penk.livejournal.com]

One would assume you haven't died yet... so that's a pretty positive point!

I guess it's a matter of how do you define good care, even from an MD? I was mainly concerned about mis-diagnosis or poor treatment assignment, but going by what I'm hearing in this thread, that's probably not a problem, not more than with an MD, and this person is far more accessible.

[wotw]

Well, what I meant was this: I've been to NPs often, I've been very happy with the interaction, and I *think* they have diagnosed and treated me as well as I could have expected from an MD. But since I can't be sure what an MD would have done, and I'm not sure what might have turned out differently, it's hard for me to know whether I'm right about that.

In other words: Things with NPs have generally turned out quite well for me. Have they turned out as well as they would have with MDs? I suspect so, but I have no way of knowing. And even if they *did* turn out as well as with MDs, would that continue to be the case if I had more interactions with them? I suspect so, but I have no way of knowing.

[dbang.livejournal.com]

It's true that in life, one does not get to peer down the paths not taken to see what the alternative outcomes would have been. This lack of lateral vision is not unique to medical choices. I don't think the word "incompetent" to describe the same limitation we all share is valid, though.

[wotw]

Frequently, we take a fork in the road and have no way of knowing what lay down the other path.

Occasionally, we have reason to think that if we were better educated, we *would* have at least a better idea of what lay down the other path.

This seems to me to be one of those occasions, which is what I intended to convey by the word "incompetent". It still strikes me as a good word choice, though "uneducated" might have been better.

[maebeth.livejournal.com]

I totally prefer to ssee the np and prefer pcp s who make good use of an np. Once I had an np whose asthma symptoms and history were the same as mine and she was THE BESST.

[iamlisabee.livejournal.com]

I visit a nurse practitioner at my practice, too. I've liked some of the docs that I've had there, but find that it is both easier to schedule with the NP and I get more time and attention from her, and I can consistently see her, so she's the one tracking my health. Because she's working with a group of MDs, I haven't worried that I'm going down the wrong path. I always feel that if I need to get a more qualified opinion, I can easily do so. I haven't felt like I've needed a more qualified opinion, though.

[melebeth]

I vastly prefer the nursing model of care and, whenever possible, will see NPs instead of MDs for primary care and women's health services.

[wispfox.livejournal.com]

I have often been far more approving of nurse practitioners than doctors. They are generally much better at what they do, for reasons that I do not entirely comprehend.

[blk]

The difference between a nurse practitioner and a doctor, according to sources I've heard from... isn't really much. Years of training, specialty in a particular field, and salary, is mostly it.

My gut says that a PhD'd medical doctor is someone you want if you have some serious illness that requires education, experience, and someone who is getting into the nitty-gritty of things. For almost all routine things, basic tests, general diagnoses, and normal treatments, I would think that a NP would be just as good.

[As for what to call her, I think Nurse X is the "proper" title, from patient to attending professional. Unless she has a Doctorate of Nursing, in which case you could probably call her Doctor X. :)]

[penk.livejournal.com]

I think my gut feel matches yours here... and others seem to be supporting it. I wonder if I should look her up to find out if she has a doctorate... that would be awesome :)

[ckd]

I've had NPs and PAs (physician assistants) as my "primary care doctor" for a while now (the practice I go to has had a mix of MDs, NPs, and PAs over the years), and have been very happy with them.

[docorion.livejournal.com]

What they all said.

In general, an NP is as good as an MD for most routine, and not a little non-routine, health care. This encompasses both primary and specialty care; the NP's who work with specialists generally get good at that specialty quite rapidly (f they weren't already good by having done that form of nursing for a while before NP school).

The credential for most NPs, I believe, is a Masters (in Nursing Practice or something like that). Some in fact have Ph.D.s

I see an NP for my health care most of the time. On occasion I'll see the doc, usually because she's available and the NP isn't for some reason. And I refer to her (the NP) as Marie (I refer to the doctor as Deborah; when referring to them in the third person, it's Ms. Botte and Dr. Bershel).

[penk.livejournal.com]

It appears the 'Ms/Mrs' vs 'Dr' as the honorific seems to be the right path. Thank you!

[ceo]

Slightly off topic, but we love Marie to little bits; our kids have the same relationship with her and Dr. Bershel that you do. :-)

[mrf-arch.livejournal.com]

I see a Physician Assistant - My PCP is the MD in the relationship, but I've actually seen him, as opposed to the PA a grand total of once in something like 20 visits over the last 10 years.

I'm sufficiently willing to self-diagnose (and to argue my case, if it comes to it) that I'm not sure there's much difference between the care it get from the PA and what I'd get from the MD. And since Fenway seems to have about two or three times as many PAs as MDs, I can also get appointments sooner.

[dbang.livejournal.com]

I will echo others: i've had, overall, better experiences with NPs than MDs. I wish I could say that was ALWAYS true. I have had a few spectacularly bad interactions with NPs. (Lots more spectacularly bad interactions with MDs though.)

Similar to NPs, you will also run into PAs (physicians assistants) with whom I've also had pretty good experience.

different types of providers

[(Anonymous)]

At the community health center where I worked the past couple of years, there are few practical differences between NPs, PAs, and MDs. I'm scheduled to see 9 patients per (3 hour) session, whereas the MDs are typically booked to see 11 or 12. So I can generally spend a little more time with each client, which is nice. I had several hundred patients (adults and kids) for whom I was the designated PCP, and also saw the patients of the MDs on my team. My panel was set up the same as any other provider, but when I met a new patient with multiple complicated (or rare) medical conditions, I would reassign them to an experienced attending physician, or someone with specialized training (e.g. the MD with an infectious-disease certification, the guy who can prescribe Suboxone, the PA with a lot of HIV+HCV experience). Sometimes reassigned patients would boomerang back to me anyway -- people try to see who they like. :) When someone presents me with a medical puzzle, I consult with another provider, which is what anyone would do regardless of their level of training.

Statutory regulations (in terms of scope of practice and oversight) differ from one state to the next. In order to diagnose, treat and prescribe in Massachusetts, I must have a designated supervising MD, a written practice agreement, and be nationally certified in my practice domain (I have ANCC certification as a 'Family NP'). In New Hampshire and Maine, on the other hand, NPs can practice without any MD involvement, although most don't. To make things more complicated, each office and insurance company has its own operating model and policies about scope of practice. For example, at my new job starting next month in Medford, I'll be a "team" NP, and won't have a panel of my own, but the types of encounters will be much the same as at my old job -- I expect to see the same patients pretty regularly and build ongoing relationships with them.

The appropriate honorific is generally "Mr/Ms Surname", unless the person happens to have a doctorate. Most of my patients call me Derek.

(FYI, doctorally-prepared NPs will become more and more common in the future, as nursing schools are being pushed by their accrediting organizations to adopt the "Doctor of Nursing Practice". I have mixed feelings about this movement, but it's a complicated issue and this is long enough already.)

-d.d-

[randysmith]

I'm pretty solidly in the "For front line care, NPs can be every bit as good as MDs, and I could imagine often being better." More specifically, I think a good relationship/respect/engagement counts for a heck of a lot, and that expertise and competence can be well evaluated by the patient. On average, I'd expect the expertise and competence of MDs to be to be greater than that of NPs, but I'd also expect the bell curves to overlap enough that an individual NP could easily be lots better than an individual MD.

[harimad.livejournal.com]

I think it depends on how complicated your medical needs usually are. Frex, I have one relative with a medical history miles long that includes three primary cancers, and takes more medications a week than most people take in a decade. This relative needs an MD to catch the Really Weird Stuff that can happen.

I think it also depends on how much one values a conversation, and how well one can assemble the relevant data in advance and make sure it gets absorbed by the busy MD. If one is shy about interrupting or correcting a misapprehension, then one really needs the conversation.

No clue what to call her. Ask? I'm generally ticked off by medical personal who say "Hi, FirstName, I'm Dr. LastName."