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Difference Between NP and MD

stethoscopeNP vs. MD

Differentiating a NP from a MD is fairly easy. Basically, a NP is a Nurse Practitioner, whereas a MD is a Doctor of Medicine. Hence, NPs are nurses, while MDs are physicians.

MD is a title – doctoral degree for doctors (medical) – that’s only granted by their schools. This is the simplest meaning of a MD. However, in some countries, both the scope and the requisites to become one may vary. The case is the same with Nurse Practitioners (NP), wherein their scope of practice is being dictated by the rules that govern the medical codes of the state or country.

Generally, Nurse Practitioners perform the same functions as the traditional Registered Nurse (RN). They can assist with diagnostic tests, provide initial treatment, assess patients, chart medical histories or data, and do some health teachings or active follow-ups on the general well being of their clients. However, they only differ from RNs in the sense that they are licensed to prescribe medicines or drugs. This is where their functions overlap with those of the MD.

NPs can perform almost the same task as the doctors, but take note that they are only nurses, and not doctors. Besides from prescribing medicine, NPs, like doctors, can also diagnose medical conditions. They can work independently in medical care facilities and hospitals, even without the support of an MD. This is contrary to RNs, who need the guidance of an MD. Due to this, they can act as one of the primary care professionals. Thus, they are often described to be the bridge between the RN and the MD.

In terms of educational requirements, NPs must meet all the requirements needed for an RN, including the passing of a state or national license examination. After this, the RN can upgrade his or her status into a full pledged NP, by taking another 2-year education or training program. This is the equivalent of attaining a standard Master’s degree for college graduates. After its completion, he or she will once again be asked to take another NP national examination.

Conversely, MDs require more years of training and practice to become an MD. In most countries, one needs to take an additional four-year medical course, on top of the four-year college degree to qualify for the medical board. This is equivalent to the standard doctorate degree, for example, a PhD. Nevertheless, licensed doctors can take residencies and further education for them to specialize in more complicated medical fields.

In summary:

1. A NP is a nurse, while a MD is a doctor.

2. A NP is licensed by the Nursing Board, whereas a MD is licensed by the Medical Doctor’s Board.

3. A MD’s education requirements are more extensive compared to those of the NP.


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71 Comments

  1. I take offence at your stating that NPs are “only” nurses. As if a nurse is in some way less than a doctor. A nurse is not less than a doctor, a nurse is not “supervised” by a doctor, nor do nurses belong to doctors.
    Nursing is a completely different discipline, and deserves recognition and respect as such.

    • Differentiating a NP from a MD is NOT easy–if it were, then there would be no question. Yes, a Nurse Practitioner (NP and midlevel) is a nurse and they are a medical provider. Yes, a Medical Doctor has a Doctor of Medicine and are also a medical provider. The only reason NPs are generalized to the title of nurses is because they have a nursing background but they have added on medical specialty education and training–making them MORE than just “nurses”. They practice both nursing and medicine. MD is a title for a doctoral degree in medicine.

      Generally, Nurse Practitioners DO NOT perform the same functions as the “traditional Registered Nurse (RN)”. Like MD’s and PA’s, they take medical histories, perform physical exams, assessm, order & interpret diagnostic tests, provide treatment,chart medical histories/data. Unbeknownst to most people both bachelor’s prepared RNs and NPs are skilled at health teaching–this is foundational in nursing (unlike medicine). Like PA’s and MDs they follow-up and assess the treatments and conditions of their clients.

      A 2 year RN (ADN) and a 4 year RN (BSN) is not licensed to prescribe medicines or treatments.

      Yes, NPs can perform almost the same assessments as their physician colleagues. If they are essentially “doctoring” and providing medical care, why the “beef” about NP’s being “just nurses”? Why should we “marginalize” the fact that NPs are performing the valuable skills of needed health care?

      Yes, NPs can work independently in medical care facilities and hospitals, without the support of an MD. This is contrary to RNs, who need the guidance of an MD (or NP). NPs primary role is to fill a gap in care that is lacking and available in urban, rural, and remote settings. They can be found working in Pediatrics, Women’s Health, Community Clinics, Geriatrics, and Family Practice. Because these areas of medicine are labor intensive and not profitable, they DO bridge the gap between RN and the MD provider.

      NPs must have a BSN degree in nursing and 1-2 years of fulltime experience working as an RN before they qualify to apply to NP school. RN’s typically choose to become NPs because they see a lack in access to medical care. Some may call this “upgrading” but really, this is similar to the expanded education that physicians receive. NP programs are rigorous involving 8 quarters of theory and clinical supervised practice to receive their Masters degree and certificate as an NP (completing approximately 7 years of college). Passing a national certifying examination allows the NP to practice within the confines of their specialty certificate. Obtaining DEA to prescribe occurs after studying Pharmacology and satisfying National requirements.

      Although, MDs have more years of training and practice (especially if they specialize). NPs really do not lag far behind them in background. It takes about 5 years of education to complete a Bachelor’s of Science in Nursing (including the prerequisites). It takes 1-2 years of fulltime hospital or home health experieince as a registered nurse. It takes a little over 2 years of fulltime education and clinical training to obtain an NP. But most NP’s have had more than 2 years of fulltime experience when they come to NP school. Most have had additional specialty training as Nurse educators in the ER, OR, ICU, CCU, Oncology, Pediatrics, Geriatrics, Women’s Health, ect…these all require hours of study and the passing of a national certifying examination.

      Because NP Masters programs were so rigorous, they created a DNP program because NP programs recognized the education and clinical training were comparable to OTHER doctoral programs (like pharmacy, physical therapy, and medicine).

      What I am saying is, don’t marginalize NPs because “nurse” is in their title. Don’t assume that NPs are just nurses and don’t deserve the respect and dignity that doctors receive. NPs provide medical care blending the best of what nursing AND medicine has to offer. NP is not just a “nurse” and is very similar to a physician. They will vary in their experience and clinical background and yet they will overlap as well. We need medical providers whose standards are high. Don’t think less of NPs be grateful that they are willing to fill the gaps in care that exist for less.

    • I am currently in medical school. Having already worked in healthcare prior to my entry I understand that nurses and other professionals are absolutely vital. When it comes to healthcare, no one should arrogantly claim one duty or title superior to another. Unfortunately, there will always be individuals in every position (nurses are guilty too) that the feel the need to belittle others in order to glorify themselves.
      As a future physician I plan to treat my colleagues, employees, and patients with the respect they deserve. I’d rather work with them, than against them.

      • Nicely said. I like the general description… As a patient it’s nice to have a CNP, but feel as though a quick visit from a MD would be nice. I respect the CNP but greatly respect the MD who has had years of specialized training in a particular medical specialty. Patients often wonder I’d they are worthy of a MD’s time.

    • This was extremely disappointing and biased. The person who wrote this article is obviously not educated on the role of the NP. The nurse practitioner may have a different scope of practice, but like the physician, the NP goes through extensive training (8 years minimum) to facilitate very similar patient care. I would appreciate a rewrite on this topic with someone who has more knowledge, and does not use ridiculous statements such as…”The NP is only a nurse.” What does that even mean? Ridiculous and very unhelpful to those looking to further their career.

      • There are superior positions in medicine, based off their education difficulty and time spent learning (e.g. my community college level of becoming a paramedic then RN is in no way/shape/form the same difficulty level or near the same amount of information that it was in becoming a M.D.). When I was a paramedic/nurse I was cocky but in no way did I think that someone that spends 14-23yrs to become an M.D. is comparable to me. For every thing I knew about e.g. mega codes ACLS as a paramedic that a M.D. student didnt know, the student M.D. knew 5000 things more then me as a paramedic/nurse. You cant compare any of these positions. My best friend is NP, NP is not 8yrs, you need a BSN, work as a nurse, then take a 1yr full time or 2yr part time program for CNP, at the difficulty question level expected of a CNP. Average M.D.school needs a M.S. degree now, must get over the MCAT which only maybe 2% of completed premeds get over this hump, Med school takes 5yrs d/t comp exams/board exams and extra semesters they dont tell you of initially (med school difficulty requires 100-120hrs dedication a wk), large % of people dont make it through med school (this includes pharmacists, PAs, chiros, etc that try to expand their understanding of medicine by going to med school), then must match for residency but if your board scores are not high enough you are screwed, average time to match is 6m0-3yrs to match, residency takes from 3-7yrs at 43k 72-120hrs a wk depending on your specialty(which depends on your board scores), after residency you do fellowship another 1-2yrs but finally get a respectful pay check. Loans for me as a med student will be 436k(with interest will be over 1.2mil, loans must be payed back while in residency or when trying to match for residency). One of my main study partners in med school was a chiropractor for 10yrs and in chiro school they told him his biochem/anatomy/path etc was same as med school, but it isnt as he mentioned and had many troubles in med school. The difficulty level in med school is harder than ANY schooling on earth period. As a CNP you do not have to learn the HOW & WHY (the root) of every single little marker/path/physio/associated factors/biopsies/micro physio/pharm behavior/seeing every little aspect inside bodies in anatomy and have a true understanding of HOW and WHY the cells in one part of an organ may have some drain off or Ab production off even a benign lesion, you do NOT have to learn near as much as a M.D. that is the difference, a CNP can never match their salt with a M.D. in an elaborate medical conversation, I know I deal with it every day in hospital and b/c I have a best friend thats a CNP. As a CNP, IMHO dont compare your less yrs of education and less difficulty level to a M.D. just embrace the M.D. and join us M.D. by taking the time to become one or just try to learn a little at work but there at work you can only learn so much. As a well educated CNP dont be innocently ignorant by comparing your less education&difficulty level, this is typical behavior of community college grads (e.g a EMT-P saying he knows more than a M.D., which I just heard the other day on a friend-fire chief’s facebook via another paramedic)…. CNPs are much more educated than that. It is very simple, the more time spent in education the more understanding/conceptually you will gain, the more difficult a program is(3rd-7th order questions, multiple choice a-r, and looking into every specialty) the more difficult-understandings you will gain conceptually… Just my 2cents, hugs to the nurses so myself included.

        • well said.
          becoming a physician takes a lot of in depth knowledge.
          It is the nurse practitioner who is arrogant to think there training
          and knowledge base are equal.
          Physicians have no reason to be arrogant.
          arrogance only leads to errors.
          A good physician recognizes their limitations.
          and never stops learning and adapting to new information and
          technology.

    • I detect the following from the NP responses given in this thread:

      – a sense of equality or, in some areas such as patient education, superiority over physicians in the quality of care of patients.

      – a belief that patient education is not as important to physicians as it is to those trained along the nursing lines.

      – a belief that a nursing-based education and training provides an equal foundation as a medicine-based education and training.

      I am genuinely surprised by the degree of antagonism expressed towards physicians. I question the objectivity and insight of those making these comments.

      Consider the tone of the following paragraph:

      In my experience, physicians are far more likely to individualize treatment and education, and NPs far more likely to follow an algorithm at the back of a book, providing generalized teaching learned verbatim that may or may not apply to a specific patient. After all, physicians go through a very intense course of training of between seven and twelve years after college with tens of thousands of hours of direct patient contact, whereas NPs can get their training over the internet (http://onlinenursingdegrees.maryville.edu).

      If that last paragraph seems antagonistic and subjective and hard to take seriously, it should. It is. Now re-read some of the comments from NPs comparing their training to physicians. Is there really much difference?

    • I absolutely agree with this! This comment should be edited. If an NP was “only” a nurse, we would not be able to diagnose, admit, prescribe, treat, etc. A nurse who is “only” a nurse, assuming we are calling a nurse an RN or LPN/LVN, can not diagnose, admit, prescribe etc. However they deserve recognition as a “NURSE” based on their education and experience and should not be disrespected to say “only”. Nurses work hard, many of them going back to school, as adults, with families, and full-time jobs, to continue their pursuit in nursing as opposed to MD’s who generally go to college straight from high school and don’t stop. Having all the extra responsibilities to deal with while going to school for nursing as an adult is difficult and generally isn’t done by Dr.’s. The author of this article is an idiot and obviously has no medical background, but good for you! You obviously know how to access wikipedia!

  2. An RN generally cannot go on to become an NP with two more years of schooling. Only BSN/RNs can do this. Most RNs have only two years of schooling. In some states, they may have less.

    A BSN/RN (a four-year degree) with an additional two years of schooling is roughly equivalent in schooling to both an MS and an MD, although the MD will go on to have a longer supervised internship. (Although, in a sense, the NP will spend the rest of her career in a position not dissimilar to an MD’s supervised internship.)

    A PhD requires more schooling than an MD.

    While it is strictly true, as you say, that “NPs can perform almost the same tasks as doctors, but take note that they are only nurses, and not doctors,” it is equally true that “doctors can perform almost the same tasks as nurses, but take note that they are only doctors, and not nurses,” and to be accurate and honest, you should state this in your article. Until this oversight is corrected, the article will continue to demonstrate a misunderstanding of the relative contributions of the nurse practitioner and physician on the health care team.

    You assume that doctors’ knowledge encompasses nurses’ knowledge, but it does not. Registered nurses tend to have more holistic knowledge than doctors; nurse practitioners bring that holistic approach to medicine. Doctors have technical and diagnostic skills which are strictly limited, as is true for other closely defined professionals. As an allied health professional on the team, I have often observed that doctors simply cannot perform many of the tasks that other health professionals, including nurses, can. They have neither the knowledge nor the skills in many areas–and why should they? In a good health care team, the individuals’ skills complement each other.

    • A PhD does not necessarily require more education than an MD. There are far too many variations and variables to make this contrast. When it comes to healthcare, no one should arrogantly claim one duty or title superior to another.

  3. So I’m reading the replies to this post… and then I realize this is why I hate most CNPs. I am tired of hearing this stupid argument. If you want to be a REAL physician doctor and make REAL diagnoses from a much BROADER differential, then go to ****ing medical school and do a full residency plus fellowship training.

    Let’s assess this in a logical way, shall we? The patient can decide…

    1) Would one rather have a CNP do their Cardiology evaluation/treatment or a Cardiologist?
    CNP: 4 years Bachelor’s to BSN; X years nursing experience; 2 years to CNP
    Cardiologist: 4 years Bachelor’s to BS/BA; 4 years medicine to MD; 3 years Internal Medicine Residency to Board Certified Internist; 3-4 years Cardiology Fellowship to Board Certified Cardiologist.

    2) Would one rather have a CNP do their Cancer evaluation/treatment or an Oncologist?
    CNP: 4 years Bachelor’s to BSN; X years nursing experience; 2 years to CNP
    Oncologist: 4 years Bachelor’s to BS/BA; 4 years medicine to MD; 3 years Internal Medicine Residency to Board Certified Internist; 3-4 years Oncology Fellowship to Board Certified Oncologist.

    3) Would one rather have a CNP do their Gastrointestinal evaluation/treatment or a Gastroenterologist?
    CNP: 4 years Bachelor’s to BSN; X years nursing experience; 2 years to CNP
    Gastroenterologist: 4 years Bachelor’s to BS/BA; 4 years medicine to MD; 3 years Internal Medicine Residency to Board Certified Internist; 3-4 years Gastroenterology Fellowship to Board Certified Gastroenterologist.

    4) Would one rather have a CNP do their Gall Bladder surgery evaluation/procedure or a General Surgeon?
    CNP: 4 years Bachelor’s to BSN; X years nursing experience; 2 years to CNP
    Oncologist: 4 years Bachelor’s to BS/BA; 4 years medicine to MD; 5 years General Surgery Residency to Board Certified General Surgeon.

    5) 2) Would one rather have a CNP do their Open Heart Surgery evaluation/surgery or a Cardiothoracic Surgeon?
    CNP: 4 years Bachelor’s to BSN; X years nursing experience; 2 years to CNP
    Oncologist: 4 years Bachelor’s to BS/BA; 4 years medicine to MD; 5 years General Surgery Residency to Board Certified General Surgeon; 3 years Cardiothoracic Surgery Fellowship to Board Certified Cardiothoracic Surgeon.

    I could go on & on & on all day long with these comparisons, because there is NO COMPARISON what-so-ever. A CNP is NOT equivalent to an MD physician and should never be described as such, there is NO EQUIVALENCE! To hell with it, let the patient decide what they want, and if they’d rather go for less quality care, then so be it, go for a CNP. The purpose and creation of the CNP is to treat simple disease mechanisms so that MD physicians can spend the time and focus on more complex disease syndromes.

    Is a CNP capable of treating acne, a head cold, and other simple disease mechanisms? YES
    Is a CNP capabe of treating aortic dissection, CNS tumor, Class IV heart failure, and other complex disease syndromes? NO

    Now I realize that my argument is seriously downplaying the role available and needed by a CNP, but damn it I’m ill from hearing idiot CNPs claim they are equivalent to physicians. They are the ONLY people making this claim and it’s ludicrious.

    TO THOSE OF YOU CNPs WHO KNOW YOU’RE ROLE IN MEDICINE, and don’t make these absurd claims of being a physician, props to you and keep up the great work.

    Enough of this stupid crap. The argument that a CNP is a physician is RIDICULOUS!!!! If you’re a CNP and you want to be a ****ing physician, go to ****ing medical school and do your residency/fellowship training.

    Source: An MD physician sick and damn tired of hearing the CNP argument that they are some how comparable or worse, equivalent, to an MD physician. Do your damn job and be happy with your niche in medicine… if you want more, then go to medical school and do the post-graduate training required.

    • I do not agree with your opinion about comparing length of MD program with NP curriculum, and thereby undermining the role of NP.

      I have been saved several times in a Hospital by Family Nurse Practitioners because of their ability of visualizing beyond what is taught in medical schools.They are very sympathetic with patients and they calmly listen Patients’ concerns. Also, they do eliminate unnecessary Diagnostics/Tests/Exams prescribed by Physicians. They are indeed the best practitioners in advocating Patients’ rights and concerns.

      I would assume if title of “MD” was very important then the NPs can easily get one in going to Medical schools at Far East and Eastern Europe. You can spend few dollars to get MD from many schools approved by WHO. FNPs can easily clear USMLE 1-2, if they are approved by Medical Board to write these exams.

      Here’s the fact about NP:

      1) They are Practitioners, and not simply a nurse. Only a jealous would call FNP, “a nurse”. Patients really do not care and would address a janitor a “doc” if he’s in a white coat.

      2) You would be surprised that more and more hospitals are hiring NPs and firing MDs since the hospitals get combo deal with FNP – they can prescribe, diagnose, administer and also “nurse” the patients.

      3) Patients prefer NPs, and based on my past experience with NPs, I suggest that MD should become NP if they want to retain a secure job in future. Too many MDs with “no nursing” experience.

      4) I wish Nursing Board could work with Medical Board and sort out the “ego” issues, because more than the title, the goal is to provide good care to Patients. Eliminate Medicare/Medicaid fraud and save healthcare industry from useless money making MD quacks, etc.

    • Reply to Alex ( I agree with you bra!):

      People that are not successful will make excuses to some how cover up what they couldnt do.
      The NP made the decision to take a short cut, maybe bad grades, most of all MCAT score was too low, and then scream they know as much as the MD. This isnt logical, but what do you expect from these type of NPs, however there are some NPs out there that listen to the MDs and actually get some free education, without the 443k loans-multiple stressful yrs of their lives, and NPs can actually start a family having kiddies which is great, me as a MD wish I could especially at my age.

      The kid at community college getting straight A’s thinks his school is just as hard as a teir 2 etc school.

      PHD programs most of the time dont even take tests, study at turtle speed, are given difficulty level of material that is suitable for a PHD student.

      NP does their BSN, works for whateva yrs as a nurse, gets into their program that is based on their suitable level of being a nurse.

      MD on average has a MS degree ( there are EMTs, paramedics, nurses, pharms, chiros, resp techs, perfusion techs, PA’s, NPs and many PHDs in med school as med students ), takes a MCAT ( which most people wouldnt score well ), has to have top grades with a respectful amounts of undergrad credits per semester, on average takes 3 yrs in application process to get accepted into med school. I myself, have worked in medical field for over 13 yrs. Someone that has not gone to medical school could NEVER understand the focus and dedication one would need to become a MD. I came from a ghetto and Im white so I didnt get a free ride, got a GED, became a firefighter/paramedic, ACLS instructor, many other medical certs, fire officer, AS in EMS management, HAZ-MAT tech, bach in neurosciencebio, MS in biomed, MCAT-med school-etcetcetc…. The best PA’s Ive met have been the type of people that understand the truth to their knowledge and LISTEN to the MDs acquiring a great amount of knowledge over years of working. I have run into a few NPs that arent a pain in the butt, but by far less than PA’s. When MD schools make a program, they expect that the student is an elite student and therefore can withstand the amount of info given to them in such a short time frame. They expect that your IQ is higher than most, they expect you to endure all of it, some PHD scientists that teach are actually annoyed that us medical student are actually doing med school , so the PHD makes tests that can go any way, this is known in med school, PHD profs Im friends with even admitted to it and explained the conversations that profs have because they are jealous they didnt have what it takes. NP do the same things depending on the personality of the NP. The average IQ fo a med student Im sure is higher than a NP, and then top on all the years of education, DIFFICULTY level etc, and there is no comparison, NPs just do your jobs be happy you make more than a chemical engineer and get to use a white coat and play DrMD.

      PRO’s vs. JOE’s:
      PRO= MD/DO like Ray Lewis MLB ravens, Mike Jordan
      JOE= NP like the kid playing flag football thinks because he is good at the park he can play NFL football delusional

      The NP is a good highschool basketball player.
      The MD is Mike Jordan

      Both compete at free throws for 5 minutes, so seemingly are the same, because Mike Jordan hasnt had a challenge. Has the NP(highschool player) played in the NBA, has he played in playoffs, has he played in the finals, has he had any sort of competition in NBA and in this conversation in medicine to guage his knowledge his mojo, no he has not, most MDs ignore arrogant NPs/PAs (PA’s way less common delusional behavior). You only know what you are when the DIFFICULTY level is comparable to the other.

      The oldest saying in the world is the only true saying: you only know what you know.

      The arrogance from these nurses NPs in practice is unreal. Kinda like telling a cuban in Miami hey speak english and they say no this is Miami.

      • So being good at memorizing a lot of crap you are going to forget in 6 months makes an MD better. PhD’s require far more studying for the class section of the phd and learning processes rather than taking courses half of which have been about memorizing parts. Due to the methodology of teaching the courses very few can actually learn the material in med school what physicians( as opposed to doctors, those with phd’s) remember is from their residency and most will answer that if you actually ask one who has been practicing. The rest of the PhDs snail paced studying is when they are Investigating completely NEW phenomena which no one knows about yet. Research requires more time than pure memorization and far more effort as it is expanding an idea as opposed to Regurgitating it. While MDs deserve a lot of credit for all practical purposes, patient outcomes, NPs do their job as well as they do for less money, and respect. So transitioning should require less time than med school since they already have a residency( clincals and post NP practice). There is no such thing as Just a physician or Just an NP they all work together and have an equivalent knowledge within thier scope of practice. Realize that it is dependant only on the practitioner as far a competency there are many who get into med school for purely political reasons who are incompetent and will kill more than they heal as there are many NPs who are incompetent. Lumping all into either category is idiocy but on the whole med school tends to be about quantity of info not quality as yet another weed out process.

        • Physicist are you serious… A new patient is a different opportunity to try to figure something NEW out every time, memorizing 1000′s of things is easy, well if it was why are you only a physicist? You should be a physicist, a MD, a chiropractor, a biochemist, you should be everything because remembering things is so easy, oh and go do the MCAT… I wish I could give the physicist a couple questions from board exams that are ONLY physics related.. You will have to use intuition, memory, difficulty via mis-leaders and false/psyc patients providing false information, then multiple choice A through G-R.. You reply to this , I will then provide you my email, I will email you a question at a specific time you say, then you have 1 minute to answer and give reply, or I will email phone if you would like… Let me know big guy

        • To physicist , talking to you about how the brain has to understand/memorize/apply information on a every day activity , is a waste of my time… The one thing in your defense is that I do think a physicist is a noble profession that deserves more coin then I made as a firefighter/paramedic 95k in the past, because your sacrifice is greater and more contributing.. IMO.. I have many former profs and classmates that are scientists, some failed out of med-school and some are still in.. I do notice that physicist backgrounds in my class have a better than average capacity to figure out NEW patients information… I had a PHD physicist in my 1st year group diagnostic group. I liked him very much, he was worth his salt…

      • Ridiculous statements of people who do not understand the NP role. It was created to help facilitate patient follow up in primary care. However, since the creation of specialties, this role has evolved and advanced. Yes, as an NP we cannot provide complicated surgery or perform a highly specialized procedure (not without proper training at least). The purpose is for the patient to receive the best care that they can, and this is done by physicians and nurse practitioners working together (NOT against each other). The argument that longer schooling is better, is not a good one. If you look at the statistics, patient care performed by nurse practitioners has been safe and well received by many patients. The nurse practitioner is not there to take away patients from doctors or challenge the doctor as the “best provider.” The role is simply to help patients receive care in a timely, efficient, and safe manner.

        • That is a very well put statement by Kristy.
          There is far too much antagonism between two groups who are meant to work together rather than compete against each other.

    • I actually asked several patient’s of mine, and they replied that they had only two to three minutes of contact/discussion with their doctor, and actually preferred the care of the ANP. MD’s forget what the definition of “quality of care” is. Perhaps it’s due to their egos, perhaps its due to the fact they dont know how to interact and communicate effectiviely with the patient’s, who knows. I do agree with you that the quality of care is usually WAY DIFFERENT for an MD vs a NP, and it’s unfortunate that MD’s lack many skills/training in providing holistic care for the patient.

    • Oh Tom….

      I agree with you! DRs AND DOs are SOOOOOO SMART, but I have way less loans than you (probably what your bitter about)- like no where close to a quarter million, I have no malpractice insurance to pay for, I’m never on call (I know you are…your just too cranky not to be), and I can spend more time with my family— all while your busy blustering about how your more awesome than everyone.

      Listen I agree MD have a way more advanced knowledge and are much better in specialized areas and with high acuity patients (heck most areas)- they have more clinical and didactic hours. And I dont pretend to be something I’m not….a MD- BUT there is a role for NPs and PAs in healthcare and they provide excellent care- they are not worthless don’t insult their role….you might need one someday…..

      Lastly…you seriously need to take a CHILL PILL! Be positive….hate gets you no where in life.

      • Nonya I agree with you, that I need to chill at times, I have gone through many miserable moments in this journey to become an M.D. esp. dealing with many miserable/type A/neurotic/ocd med students (although needed to get through with competitive scores). I never thought it would be so difficult and so long with many hidden semesters and red tape. Loans for we will be roughly $450k +/- not including interest. Now add more difficulty for us now (just raised STEP 2 score minimum by 9 points, which is a huge increase, plus getting anywhere close to minimum score will never get you matched for residency/something NP’s and PA’s have no worries ok). Residency applications alone will cost me $4k out of pocket. I agree, many med students whine, play victim, are depressed/angered, not b/c of medicine, but b/c a human being can only endure so much before they crack. Like I said before, I like everyone in medical care, especially love being around PA’s and NP’s on rotations (I can BS with PA’s/NP’s and can actually act like a normal chillaxed person), on the other hand being around other med students that are so stressed/depressed/angered drives me insane , they are warned every day that they may not match for residency unless they are the best/highest scores/etc etc, they rub off on me and make me even worse, the residents can be miserable jerks as well (which I understand given their miserable life style not by their mandatory choice). I wish every day, that I would have just gone the PA/NP route, b/c this miserable nightmare of becoming a M.D. isnt worth my health/happiness/and too many yrs of my life reading books & in hospitals in a overly competitive/neurotic life style. e.g. spent 3yrs school fire/medic a.s. , got masters m.s. yrs later, 1 yr prep mcat, 4.7 yrs med school at end now, then will have 7 yrs residency just in becoming a endo (3 yrs internal med, 3 yrs fellowship residency)

        • Hi Tom,

          I have seen great NP and MD interactions in the work place. I have mostly seen great work ethics from both. NP love being taught new things from MDs and I believe MDs love the holistic information from nurses, NP, respiratory tech and even MD explore this area. I have seen great interdisciplinary care when both NP and MD work together. I have seen this with the younger MD especially. Young MDs love help and guidance and are not afraid to ask a NP or a nurse a question or two. In return, the NPs and nurses feel much better communicating with the MD. In the end, we both want to reach that one ultimate goal…To take care of the patient! There is a few overlap between the two but both have distinct roles. I think a great work environment with less unnecessary stress can come from working together and fortunately this is becoming a reality. I rarely see fighting and competition between NP and MD. Once this is solved, I think you would feel that passion of becoming a MD in many other light. NP want to care and help as well. Be happy working together to reach that goal of helping patients. I love MDs. I love NPs. Together, they are just even better for the patients. Tom, congrats on your journey and your accomplishments. We need you. Patients need you. Continue to educate a NP with kindness and in return, be open to what a NP might say in return. NP all know you have a fountain of wisdom to share and we respect you highly. Don’t let the few bad experience ruin it for the rest. :) . Also, remember you are human and can’t do everything. Ask for help and take care of yourself. A healthy and happy MD makes a great asset to everyone.

  4. The MD that wrote the last comment did not have a vast knowledge about specialisations in the health care field. He just marginalized the field, has he forgotten that CNP can also proceed on their PhD, they can also proceed on fellowship training and become fellows too. One major thing people has left out is the fact that nursing sciences is outrightly diffent from medical sciences,understand that a dilligent nursing does even more wonder than a good surgery. Although nursing sciences involves medical sciences amongst other stuffs while a MD can boast of little or no knowledge of nursing

  5. When contrasting physicians, PA’s, and NP’s, pros and cons to each become apparent. Success is determined far less by title when compared to the character of the individual. Everyone has their niche in healthcare and NOBODY is perfect. Those who loudly boast superiority over others are usually the furthest from it.

    There’s a Scottish proverb that says, “What E’re Thou Art, Act Well Thy Part”.

  6. Np is a nurse with 2 yrs of a very very easy programcompared to MD program.
    PHD is 4 yrs +/- depending on program like breast cancer PHD research science is much longer. However, all PHD programs are a joke compared to difficulty of MD program. I have both.
    The difficulty level of Nurse, NP, Paramedic, or PHD science is in any way shape or form the difficulty as a MD program. I know because I have many finished many of the above.
    MD school finishes full semester PHD books in 2 weeks along with doing many classes, the most significant difference is the difficulty level of exams which is the main difference.
    2 months in MD school is a LIFE-TIME, i would love it if they would make NPs, nurses,PAs, PHDs do at least 4months of Medical School and suffer the death blows they would get and test their back bone putting them through a mans program. This could take some of their ignorant, cocky, undereducated medical background mindset out of them.
    Also the pressure should be put on them that if they cant hang they lose everything they ever worked for. And in MD programs they dont pat you on the back and try to help, they test your mind, body, and spirit to see if you can withstand the HELL you will have to endure tolearn so much info at mach speed and difficulty levels that will twist your mind.
    NPs complaign about having to possibly do 1000 hrs work before writing scripts. Unreal, MDs learn 100x more have to go through so many years of school, multiple boards, rotations at 100+ hrs week and get home and study more, do residency 100+ hrs a week get home do more, lasting 15yrs+ and they complaign… Unreal… They no nothing of medicine and write scripts all day long, they think they know everything which is typical of an undereducated person. Anyways I have to get back to studying, because im a MD, not a NP. I only wrote this because these NP’s and PAs are very annoying in hospital. Just do your jobs, you guys dont know much to logically think through things. I used to be one.

    • Your thoughts have some truth to them. Unfortunately, they also reveal how absurdly prideful you are.

      By the way, try using spell check next time.

      • If your healthy,Iwould imagin that you understood word recognition correct? Maybe my spelling was off, maybe I dont care, maybe it is not important in this forum. Yes I have pride, I have lots of pride. You bet more than you can imagin. I had the same pride when I was a LT.firefighter/medic ACLSinstructor and people that knew CPR thought they knew as much as a medic.. Go through med school, learn learn learn, otherwise just do your job and chilax tough guy.

        • To Tom:

          How come all you ever see on these boards are “doctors” boasting on how smart they are as “doctors” who can’t spell or use the english language with ANY level of intelligence? Is it maybe that you are not a doctor after all? Or maybe it’s that you became a “doctor” via an off shore (read this as non-American) medical school that was more interested in your money than your ability to communicate with patients.

          Either way, I find it hard to believe that if you and people like you were really such great “doctors” you would have as much free time to comment and belittle everyone on every internet site.

          Oh and by the way the words “your” and “you’re” have two completely different meanings. Probably should have learned that in English Composition (required by most medical schools) and for the Verbal Reasoning portion of the MCAT.

    • GG, I like you. Well put. Look everyone, MD’s and NP’s are soooo different yet, sooo similar. Notice the extra “o” on different. The NP, MD, and DO can co-exist. They all approach things differently and have very different educational backgrounds. We are all our own contrarians. Most likely, if you took opinions, on the proper care for a patient, from a MD,PA,DO, and an NP and you then met in the middle, you would probably have the correct answer. So, for all you who type tough, argue for the sake of arguing, and who are so so so closed minded………….put that in your pipe and smoke it.

  7. In reply to Tom:

    Once again, someone with MD title is scared about his/her job in hospital because NPs/PAs are taking away market share.

    Just for your information, as you speak with top of your lungs about your long curriculum in medicine, more and more hospitals and nursing homes will be hiring NP cardiologists, other NP specialists and PAs and therefore, will be eliminating MD positions. The reason is obvious, the hospitals and nursing homes do not find difference in care provided by NPs (google study on role of NP by NIH) in comparison to MDs. The MDs are better of being specialists- which may also be taken by NPs/PA in future

    Besides, I love the NPs holistic side of curing and would prefer to get treated by NPs since they have different approach. Have you ever wondered why more and more MDs are switching to alternative medicines and holistic curing? Watch Dr. Oz show daily.

    I am very much satisfied with my NP and I got rid of MD physician.

    • MD are not scared for our jobs. We are scared for the patients. Crazy when the little NP gets cocky , giving meds protocol style ( i wonder if NPs understand what protocol style is). MD’s are scared about the ignnorance ( whoops too many letter n’s in prior word) of the citizens that watch 40 hrs of TV a week, watch Kardashians, jersey shore, etc, because it is the same people that believe the NP when he/she says they know just as much, with their littlepart-time program reminds me of when I used to compare communit college to a teir2 university… Try taking the USMLE, get owned, Idont think a NP could get 10% correct, answer choices go up toletter R by the way.

      • Well lets us give the ultimate test.
        All doctors walk out and leave the hospital.
        then see how long the hospital stays open.
        MD’s are in undersupply.

    • NP hollistic is that a joke, you are actually serious wow. Hollistic , a NP a protocol manager to not get sued. Hollistic in regards to you the NP, you need to go learn the basics of medicine first, instead you guys jump straight to the superficial clinical aspect of medicine branched off your nurse education, and somehow also think thats all that is significant, but then claim you know hollistic medicine. You claim ohhh I the NP know it all with my little part-time school, and have a hollistic approach lol… Hollitic PHD are hollistic Drs, they know hollistics, MD even learn some aspects of hollistic approaches ( but are not hollistics). I also see many people coming in to hospital, clinics, etc because they just wanted to take their herbs, look at Steve Jobs. I have asked NPs very basic questions in hospital, and the NP every time if dont know, say ohhhh thats a specialist thing lol ( its like their get out of jail free card ). If you think these herbs etc are going to fix all , that is pretty funny. We MD learn lots about herbs, it is because so many people are on them due to the 34 bil spent on marketing, people google it and are on the whole shelf cleaning out the vitamin stores after watching Dr.Oz. I remember when i was a medic , I was upset at a dr for witholding 02 NC 4LPM in a renal failure pt also having hep B and currently some what stable VS. I as amedic thought ohhh that Dr is a narcassistic jerk ohh just bc he is a dr, but i didnt know the half of it… I dont think any NP on this site would know off the top of their head, and no I know your basic mind-set is thinking directly to COPD, they do not have COPD, the NP will have to go research this for hrs I bet.

    • NP’s with your attitude remind me of illegal MEXICANS , the hospital is the liberal or the Biz that hires the low wage NP ( illegal Mexican ) markets the idea that NPs are great because this only helps the biz of hospitals as long as the NP stays within protocol. The illegal mexican screws up the packaging for the manufacturing company, goes to ER every other weekend and costs everyone money, goes to school for free, cost 60k/yr per person in prison, takes jobs away from english speaking smart strong americans that do a much better job-thats evident just look at mexico is a crap hole. NP though is so superficial in diagnosis so just gives legal protocol med, runs numerous Lab exams because they couldnt figure it out without numerous labs, I mean ask any PATHOLIGIST MD in hospital , I can remember so many times sitting at lunch with them and hear them pissed because all these NPs in the hospital costing patients money. Not to mention every time you dont diagnose properly and patients have to keep coming back causes more problems for the patient, I have seen this numerous times in healthcare and many more in NPs because they just dont understand much. Can you as NP think that a nurse is going to understand your thought pattern in diagnosis, and their education is not that far from yours?

      • Tom,
        Your argument(incessant ranting) is nothing but a blur of misused, or misspelled words, and poor grammar. The only information that can be derived from what you’ve written is this:

        (1) You dislike NPs.
        (2) You may or may not be a doctor of medicine. Your lack of professionalism, spelling and grammar ability, and composure suggests that you are not.
        (3) You’re angry, spiteful, and biased.

        From these things, I can conclude that I would never want to receive care or advice from someone like you even if my life depended on it, and I’d prefer and NP for myself and my family.

        I understand you disagree, but if you’re going to post on things like this, may I suggest being a tad more objective, composed, and respectable. Having and M.D. does not give you license to be rude or arrogant.

        • I dont pay attention to my spelling nor do I spacing or typing on this blog. Your brain doesnt look at each and every letter to understand the meaning of a word. Im fluent in spanish and english. I have been a bartender, a subcontracted shingle-to-shingle roofer, dishwasher, lawn care provider, bouncer, security guard, and currently own a few internet companies that I do webdesign and SEO on, small companies with a few employees. Yes , I am a M.D. 4th yr student, and a former L.T. Fire/paramedic-hazmat tech, with many other certs including phlebotomy cert from nursing unlimited in my early years, M.S. in neurobio, and in 4th yr M.D. school. I only get angry at NPs that are arrogant, say they are holistic etc and all your sales pitches. Your argument is from a patient, a patient that would believe even a paramedic, a nurse, a EMT, or any other around. How would the patient understand science-medicine.

          Of course the patient will like a NP that spends more time with them than the MD did. If I was the patient I would think the same. Shame on the M.D. I agree. Flipside, sometimes the M.D. spends more time with the patient than the NP etc. This is just basic business-service that any normal person should give, this has nothing to do with this argument that was posted higher up in this blog.

          My lack of professionalism and composure you say makes me not an M.D. ? I didnt know I had to be so sweet and nurture you the NP even here on this blog. I didnt know this blog had a mandated proffessionalism attitude, I mean when I was reading the initial blog this was not the case. So because Im not typing proffessional on this blog, that makes me not an MD.

          Im a MD and run some pretty darn good internet companies, all of us arent spoon-fed kids being tutored since we were 3 y/o.

          Angry? you bet, Im sick of school for so many yrs, im sick of having no life, because its always studying, rotations, many many hours, im sick of not yet being able to start a family, im sick of my wife being stressed because Im stressed out of my mind, im sick of seeing people having fun, people getting good sleep and going to gym, im sick of seeing people having kids starting a family, im sick of not feeling healthy and getting sick-or severe back problems from all the yrs studying, im sick of not being able to relax and just be able to not worry about studying-rotations-tests that my life depends on, im sick of not being able to watch TV, go to a fball game or spend time with friends and family, im sick of not being able to concentrate on making money concentrating on my retirement, im sick of wondering if im a idiot trying to become the most difficult proffession there is to become and by giving up my pension from firerescue that would have taking care of me for life, im sick of people wanting healthcare for free when they got to enjoy their lives, im sick of people wanting their healthcare fore minimal-dont want to pay labs but meanwhile they drive nice cars-go out to eat all the time-smoke 2pks of cigs a day-they will pay the car mechanic $1500 for a transmission damage, im sick of people thinking they will never get sick so they never save their money for a unhealthy moment in time, im sick of people feeling I need to work for minimal- i dont tell the aircondition man to not make money and he may make 200k a yr and tells the govt he makes 50k a yr so doesnt pay taxes, Since firerescue days I have been doing for yrs and will do more of is help elderly for free bc they cant take care of self on SS this is my choice, im sick of truly needing to be neurotic and OCD to be able to study all the time in order to become a MD, im sick of fighting every day to not give up for many years before I finally get rewarded, im sick of the final outcome of 436k in loans not including interest that will generate >2x the amount by the time im done with 5-7 yrs residency, then 1yr fellowship also need to add in time for 2 more boards.

          Im sick of NPs that cry about 1/2 pay +/- as MDs, minimal yrs-stress, minimal loans, crying that you have to possibly in SOME states do 1000 hrs before you can write scripts on own, really are you serious, so when you cry about how hard it is, yes MDs are going to get pissed. I will help who I want, I will listen to pts even though I cant bill them properly for my sacrifice to become an MD, but people that may demand my help, well I may just shove my foot up their arse sending them flying out the door.

          Kinda, like me as an American saying how hard it is here, when meeting my wife in colombia and seeing how poor they were with no job opportunity, no appliances, no hot water etc, or telling nigerians in my class how hard it is to be here in america. This pisses them off, wouldnt you be, so when I say you dont understand, its bc you DONT!!!! just do your job, you guys are great and needed, only a person that wants to get tortured wants to be an MD. You made a smart decision, just take your money and run….

      • Tom, you’re also a douche. I think you need some self-confidence and………maybe a punching bag? You made your decisions for you, I hope, and not for anybody else so, sssstttttoooopppp complaining about the MD-NP comparrison. You know what you are and how hard you worked. If you base your self worth on other people appreciating what your doing then you will never be happy and you will keep getting called a douche.

        • To Prep: Yea i agree I have become unbalanced and a douche at times d/t stress/no life/taking it up the rear. My training on punching bags/weights/rolling is my peace/relax time/my sueno, too bad I dont have a prep volunteer to be my punching bag so I can lecture the meaning of a douche :p

    • Bravo House MD. You hit it on the nail. That is precisely the most accurate description of the NP role. NP’s especially those practicing in specific specialties such as myself who is practicing in Endocrinology do an outstanding job. I am very proud of it.

  8. I’m leaving this blog. People’s manner has gone to hell.

  9. No one said people in nursing wanted to go into medical school. NP curriculum was not created to take over medicine. Curriculum is entirely different. Do some research and you will see the difference in focus.

    I thought the whole point of the health care is to work as a team. I certainly would not want to be treated by a provider that does not know how to collaborate with their own team members. Obviously, the people who look down upon their own colleagues receive little respect.

    Nurses need to collaborate with physicians and physicians need to collaborate with nurses. When you’re missing a member of the team, you might as well cut your arm or leg off. You’re disabled from providing excellent care anyways.

    • Reply to Kim..

      I agree with your every word Kim. Medicine is the most complicated field to work in, and help is needed from everyone. I only responded like above (stressed/defensive/miserable/and angry), because sometimes people with much less education, difficulty, and years of sacrifice(learning lots), compare their sacrifice to ours, this upsets us MDs very much ( but most MDs just ignore it and dont even try to explain). Afterall we go through hell and back to learn everything at a very high rate and for many years. Listen, when I was a Paramedic I thought I was a hotshot with running codes, I thought I knew everything about emergency medicine and acls codes, well I sure found out I really didnt know squat ( I had the mindset of a paramedic ) ( less educated/less brain exercise), I understand the mindset of people that just wouldnt understand, I used to be one of them.
      Scenario in my experience, some backwoods guy thats a e.g. a first responder, he may say to the nurse/NP/PA/MD etc “what do you guys know, you just one of them suits, wth do you know im working out here without fancy hospital tools and you just have one of those college degrees, you think your a hotshot with that big fancy degree, but its just a paper :)
      People never talk about the journey-sacrifice one needs to become that profession, all the stress that one endures, people just look at the outcome like what $ they make, what they see with their eyes, maybe the MD looking over a pts shoulder(mentioned in prior post) seeming somewhat cold is because he may be thinking of much more material than the nurse, so it may take away from the MDs charisma-warmth to the pt but it requires a cold/neurotic/ocd behavior to become an MD without failing out. Many MDs were sheltered/highly educated kids, worked very hard >15+ yrs to become an MD to finally get a halfway normal life and paycheck, in IMO in my experience so far, is that these yrs of needing to be cold/neurotic/OCD (so you dont fail and are left with huge loans/and a waste of time) these behaviors carry over after your 15-20 yrs, this doesnt surprise me because we are human, eventhough we feel like robots…. It is great, that others in the hospital have more common life experiences or business backgrounds (keeps me as and older student sane), because these things are lacking in our lives becoming an MD. I mean the other day, another student asked me the difference between the 2 political parties, haha some of these adult students lack life experience because they been learning for so many yrs in a dungeon and havent had time to get out there and maybe learn how to be warm/make comforting jokes/and be charasmatic to pts. But these things can be learned on every day life later on, hopefully :) .

      One of my childhood friends is a NP, he failed/droped out of med school (I dont ask him which one, bc its a sensitive subject), he also got divorsed at same time, because his wife in a english grad school program didnt want to deal with his stress. He got remarried, had kids, went into a PT program and dropped out because it was too demanding, so he finally became a nurse then a NP because he didnt have to spend as much time with school. Im very familiar with the NP program, and listen to what he says about it, and he tells me all the time, better Im going through all this crap then him, because he just couldnt deal with it.
      Even at a school that has DO/and other allied health care (e.g Dentist,PT,Pharmacy,Optometry,PA,NP) I have many friends at one of these schools, and most people say after DO, the dentist program is 2nd in difficulty and not even close to the DO programs difficulty level, PT > NP/PA difficulty, and this is from many friends. I mean, my buddy did a part-time online NP program for 2 yrs and said it was very comfortable/layed back etc, on occasion would have to drive into school, he was also able to have time to work as a nurse etc. You can never compare someone doing less difficulty of a program, less time studying, less years of school, to someone that does more in every category, this is common sense.
      Anyways, im starting to feel like an idiot posting this blog, because I really have to get back to the books and not spend any minutes on anything outside my studying, my wife would kill me if she saw me wasting time typing here and not concentrating on my exams, Im too damn social compared to other MD students and need to be cold/non-social so I can ensure I make it through, every minute counts and time/exams wait for no man!

      • Look Tommy, I know a lot of educated people who are still idiots. For instance, people who spend time actually trying to change people’s minds over a blog on the Internet.

  10. I think the problem here is the original article -
    It was written by someone who is probably neither an MD or an NP… no, they are probably an internet blogger. Some people relish at the thought of stirring conflict.

    Hierarchal attitudes in health care drive a wedge between professional relationships.
    The only person who suffers is the patient.
    There are many dynamics which contribute.
    As a nurse (BSN), who originally had a background in Biology/Chemistry/Genetics/Math, I can appreciate the obscene amount of knowledge MD’s have… and the difficulty of the MCAT (I have been studying).
    I can also now appreciate the value of all the “fluff” I have had to learn during my education… as it is applicable in my day to day interactions with other humans.
    I have always been a very black and white, concrete facts, etc. type person- a perfectionist and anal retentive.
    I remember having a conversationg with my grandmother’s rheumatologist, and he said to me “my daughter is in nursing. I don’t know why they teach you some things, it’s not important to you, you don’t need to know it”… now he never said what those things were. I took it to mean the “fluffy” communication stuff, because OF COURSE, pathophysiology and pharmacology is important!? If I just blindly administer a medication knowing nothing about it, perhaps the patient has been presenting with other symptoms the MD is unaware of because he has been too busy to come see the patient, and when you call them, they tell you to fuck off, (understandable….. people are demanding). If I wasn’t able to critically think about whether I am doing the right thing… (or ok for example, a patient who is on an antihypertensive that the MD ordered, but his blood pressure is in his boots…. one could reason that even an idiot would know you shouldn’t give it. But it is not common sense. It is that bit of, however unimportant, pharmacology and patho education we receive that should tell us HEY dummy, maybe hold that medication). Looking back on this conversation I think he meant that the patho and pharmacology and the SCIENCE based education was what we did not need as nurses. He is old fashioned…. I think he meant we should STFU and follow orders. Not that orders shouldn’t be followed….(bet he is THRILLED his daughter is going into nursing, lol) however, much like Tom says that MD’s may act like robots but are human- nurses are not robots either…. and a good nurse will think about the order rationally. What if the MD just got served with divorce papers and is lacking clarity of thought because he is thinking about chopping his wife into 1000 pieces???
    I will admit, there are some arrogant, cantankerous old bitches of nurses… but FYI- they are not only obnoxious to you MD’s… but to the rest of their nursing colleagues too. Yes experiential knowledge is important. Yes I have had MD students ask me how to do things. Now why the HELL would I act in any other way but obliged to help someone who asked for it?
    A lot of the hostility has to do with feminism and power dynamics. Those same arrogant nurses are the ones who perceive lack of control.

    I do believe when the word “holistic” was used- it was not meant to describe complementary alternative medicines, herbs, etc exclusively. Although knowledge of those types of things are useful… especially because some interactions with medications may occur….
    But I believe what was meant was the physiological, psychosocial, environmental etc. aspects of the person.
    I know the doctors are there to deal with the pathyphysiological problems of the patient, and they do a damn good job… and I know the patients sometimes wish the doctor would sit down with them and listen to their life story or their illness experience… how it has affected their home life – maybe they are the main breadwinner – maybe the stress of the illness is being somatasized, who knows.
    That’s where the nurse comes in. We at the bedside ask the questions and spend time listening to the patient’s WHOLE experience, being able to offer referrals and advocacy where needed- because they are, after all, not robots either! They are human beings. And much as an MD may be stressed within an inch of his life during med school, with finances, family issues, not being able to have fun, not being able to sleep, physical pain, etc… imagine a young father who has cancer. You can bet he is feeling all the same things…
    Which brings me to my point.
    Not one profession should devalue the other.
    Yes, MD’s have more education than nurses. Both are admirable professions, for different (yet similar) reasons.
    The amount of personal sacrifice of MD’s is huge.
    But to place value on someone based on educational merits is very unethical.
    Perhaps certain people were denied opportunities, social status inequalities, etc. but are in no way intellectually inferior.
    Tom, you did say you were a firefighter. Many people would agree that would make you a hero.
    It is but another form of self sacrifice.
    Any profession in which one puts another’s life, happiness, safety, etc. in front of their own (being a parent, lol)… could be considered admirable.

    You will meet assholes in every profession, know it alls, EVERYWHERE… one janitor thinks his mopping technique is far superior to anothers’. You catch my drift.
    Take these people with a grain of salt.
    All that matters is YOU do the best you can do, and you at least TRY to work together, for the sake of the patient.
    Everyone you meet can teach you a valuable lesson….even if it is a lesson in supressing rage. Haha.

  11. I’m not an MD nor an NP. I don’t understand! If MDs think NPs are dumbshit, why do they keep hiring NPs?

    • They just don’t want their territory encroached on and the medical model in which they go to school is very hierarchical. They were hazed from 1st yr to 2nd year etc I guess that mentality of putting others down continues…. Obviously if they thought NP or PAs were dumb no one would have jobs…. again and NPs aren’t trying to be Drs…I dont wanna be….

  12. J,

    I am neither an MD nor an NP myself, but I have a good friend who is an MD and I see an NP as my primary care provider. In short, the views expressed on this site, as with the internet as a whole, DO NOT represent the views of the majority of the people.

    Simply put real MDs (and I have my doubts as to the validity of the claims of doctorate by posters on this and other sites) hire NPs to work with them because, as others have said, the collaboration is good for the patient. It also helps with issues like insurance reimbursement, etc. For example, my wife had to go to a pulmonologist due to sleep apnea. Her insurance will not pay at the physician rate for follow ups without additional complications, BUT they do require that she have follow up visits ever six months to continue paying for her CPAP machine. The physician then has two choices: 1) see my wife at the lower rate and thusly loose time (and money) in which he could be seeing more critical patients in hospitals, etc., or 2) hire a midlevel provider (PA or NP) to see his patients on follow up and manage their care. This particular doctor decided on option 2, and he decided on an NP (by his own admission) because the NP was able to work more independently than a PA would have been able to in this setting.

    Now keep in mind the above scenario addresses the hiring of NPs by MDs in settings such as acute or specialized care. Many NPs, however, are self employed as primary care providers and must compete with other NPs, MDs, and even DOs to get patients. But this is not unique to the primary care NP since the primary care MD (or DO) must also compete (since it is a business) for patients. As such, I suspect that many of the legitimate MDs you hear complaining about NPs, PAs, or DOs had no clue that along with being good at medicine you also had to be good at business when they signed up for medical school and decided on a primary care residency and career path. Money, or the lack there-of, especially in the face of large debt will make many people behave differently than they normally would.

    Still, I stand behind my first assertion that 1) most of the people claiming to be MDs on sites like this most likely are not (heck I could claim to be from the planet Jupiter but that doesn’t make it so), and 2) the VERY FEW who actually are MDs and complain DO NOT represent the vast majority of MDs. Remember the loudest dog gets noticed first.

    CB

    • Also I know a few NPs that were accepted to medical school and they didn’t go (all for different reasons) wanted to start a family sooner, one wanted to travel, and some were just burnt out on school and didn’t want to take on that big of a task (because I know that MD students have to work very hard). But just because your a Dr does not mean your better than ANYONE as a person….

  13. This might be stupidly simple, but…
    1) Doctors are indeed better! …in their OWN FIELD of expertise (medicine)
    2) Nurses are better…in THEIR respective field of expertise (nursing)

    Of course there are overlaps, but they are vastly different fields. Doctors only claim to be better in medicine, not in nursing.

    Doctors and nurses each have their own niche in the healthcare system, their own fields of expertise, their own jobs, etc.
    Therefore it makes no sense to me to say that NPs are “pretty much family doctors.” They are important, but they are not doctors (just like doctors are not NPs).

    The shortage of family doctors doesn’t justify this either. The answer should be to train more doctors, NOT to make-do by dragging nurses from their own jobs (and we also have a shortage of nurses too) to serve as “substitute-doctors.”

    • Folks are not seeing the financial boon of NPs to the mega-medical corprations and even larger pharmaceutical companies. NPs write prescriptions. Lots of them. They are paid significantly less than actual physicians. This is a financial boon to big pharma, corporate medicine, and socialized medicine, who are all counting on the fact that patients won’t know the difference. This argument is like rearranging deck chairs on the Titanic.

  14. Tom,
    I, like you, have a background in Emergency Medicine. I went to nursing school early and spent years collecting certifications and teaching paramedics, getting ACLS, PALS, ECRN, etc. I toyed with med school,dental, and law school and kept on taking math and science classes. I visited campuses and met with directors. 3 years ago I got into anesthesia school. It was unbelievable cool. And horrific. What I learned was beyond fascinating. My head spun with the science and what receptor made the next activate. I lost many nights of sleep diagraming the acid base curves. I lost your dignity and swallowed my self-respect on a daily basis and was reminded that someone next in line that would be happy to take my place in the program. My son started having a breakdown. I never saw my family and was missing everything that mattered. I couldn’t keep doing it. I voluntarily withdrew and switched program tracks to Nurse Practitioner. It’s a whole different ball of wax. I sleep now. I have my life back. It covers different material- just as it was intended to. Please don’t think that Nurse Practitioners don’t know really what we don’t know. We do. And we give kudos to MD’s for your sacrifices. We need to collaborate with you (and not just because of the laws in some states!). But most of us have no interest in going to medical school, and each of us have our own reasons for that. It makes us no less intelligent, engaged, or committed to the practice of medicine or nursing. So thank you for bleeding and sweating right now. Few people will ever get what you have gone through and how difficult it really is. I think you what you really want is some respect. Thank you for busting your a**. We need doctors too.

    • GG,
      Sorry to hear your son breakdown, but everything is for a reason, and your choice was great IMO. The majority of medical students have dad/moms credit card to take care of bills as well. Thanks for the classy comments that you made, I should learn to do the same more often and not let the stress etc change me.

  15. I’ve met M.D.’s who are dumber than a box of rocks. Book smart doesn’t always mean you can apply what you learned. There are M.D.’s (most) who could build a space shuttle be 9pm tomorrow night, but couldn’t lose 7 lb.’s of body fat to save their life. They are intelligent when it comes to the human body in many aspects. They are superiorly stupid in others.

  16. I don’t work in one of these professions so I feel I can be fairly objective on this. The NP is a great role and all I have had as providers are fabulous. However, Reviewing the training and requirements (which I have done in detail) there really is no comparison, and reading the NP discussion regarding the DNP movement is depressing.

    My interest in this discussion stems from the over credentialization issue in the US. If NPs want to prove themselves as equals they should take the boards rather than adding on a few borderline relevant classes. If they just want to improve their field they should introduce much stricter entry requirements, similar to the MCAT’s to enter graduate school and require harder exams and more clinical hours on completion. Otherwise the whole DNP movement looks to people outside the profession like just another ploy to drive up percieved prestige and incomes at the expense of consumers.

  17. Through my experience, I have been able to observe many nurses, medical students, nurse practitioner students, MDs, and NPs in depth. A graduated NP is very comparable in 95% of care that people need on a daily basis. They can mange the big conditions of hypertension, diabetes, obesity, cholesterol problems, thryroid conditions, and the like. However, in specialty situations, there is not the same depth of knowledge acquired from schooling. The question remains, how much knowledge is really necessary? Is it necessary to know each of the steps of the Crebs cycle? Is it imperative to know which factors are affected by the various anticoagulants? In reality, no. It may have a very slight chance of giving someone the insight to go against the algorithms, but most people once they’re out of school are not going to know all those details after a couple years unless they’re immersed in the subject on a regular basis.

    Interestingly, I have to say the demographics of NPs and MDs vary greatly. Often the individuals I observed going into medical schools (and of course there were exceptions), had a relative who was a medical doctor, came from money already, and many desire to gain the prestige coming from specializations (i.e. surgery, cardiology, etc.). The average NP is an individual who worked as a nurse for several years, and after being a charge nurse or supervisor for some time, decided to pursue an expanded scope of practice to their already gained experience in the hospital.

    NP programs today require a bachelor of science in nursing (usually 2-3 years of medical based education), then a master degree (usually 2 years but can be expedited to 1.5 in some programs), and then additional school-guided clinical residency hours to take on the certification exams (3.5-5 years of medical based education). They do not have a residency.

    If I understand it right, this can help the objectivity of the schooling. Please correct me if I am wrong as I’m sure there are exceptions:

    MD and DO programs often have an individual who has a bachelor degree (master can improve admission to a better school), but it is not necessary to have any medical education in that degree. Medical school is usually 4 years, but can be expedited to 3 years in some programs. However, there is then the residency, usually 1-8 years afterward. This variance depends on the specialty, with some of the crazy unique specialties (i.e. pediatric neurosurgery, or neuroopthalmology) requiring the most. They however had the same 3-4 years of medical school. This may then require a fellowship afterward for those specialties to gain the recognition and prestige required to compete with similar surgical specialists (but not all need to do this). All that said, MDs and DOs often require 3-4 years of medical based schooling, followed by usually 2 years of residency. Total: 6 years.

    When I graduated from my NP school, I found myself to be comparable to most of those medical students who graduated from school, prior to their residency. Really, the residency is a great way to gain experience with a structured system with checks and balances to allow individuals to provide care with some supervision. While my NP school did not go into the depth of the science that most of the medical students had, I was also significantly advanced at the basics of communicating, educating, and knowing what really mattered for people because of my nursing background.

    Outside that, I believe currently 36 states don’t even require NP’s to practice with any other provider supervision. All that said, the scope of practice varies but all include not just prescribing and diagnosing, but basic procedures, treatments, lab/imaging orders and interpretations.

    Interestingly, studies have shown that the communication about medicine is just as important (and at times more important) than that of knowing some of the in-depth science. Personally, I think it really balances out and I appreciate asking one of my colleagues who has more in-depth knowledge about a subject that I don’t know. However, my MD and DO colleagues (those who I hang out with where money is not so important in community healthcare) also appreciate my expertise and have recommended patients to be seen by me because of my demeanor and understanding of the day-to-day life with a condition. Additionally, I’ve been in more codes than most of my MD colleagues and feel more comfortable when a person has a heart attack or stops breathing in our clinic.

    While NPs are relatively young in the grand scheme of medicine, it’s about providing the best care, and the system has shown NPs have a significant place on improving that. And while they are not the same, this makes it not a hierarchical system, but rather a system with different complimentary specialties that overlap.

  18. To All,

    I am a little disheartened by the lack of understanding about the NP profession that is apparent throughout this blog. The average NP attends college for approximately 7 years. While their educational preparation is a year or so less than that of the average physician, they enter the field with years of hands on experience from their career as a RN. All to often, people tend to forget that nurses were working in the medical field, assessing patients, initiating life saving interventions, and have years of familiarity with their given field before graduating from their masters or doctorate programs. The average graduating medical student does not have nearly as much experience in patient care, health systems, or team collaboration as the traditional new graduate NP. So, I would like this to be a consideration when comparing the experience of “new graduates” in both fields. I don’t know that one more year of medical education could replace the average of 5 years of hands on patient care experience NPs have before attending graduate school.

    Also, I would like others to know that nursing is a science major that is in fact very challenging. In order to apply for most undergraduate BSN nursing programs students must complete, with very high academic standing, college courses which include: anatomy, physiology, pathophysiology, chemistry, organic chemistry, biochemistry, statistics, pharmacology, two upper level psychology courses, a nutrition course, biology, and clinical microbiology. Again, I will restate that nursing is a SCIENCE major. In my undergraduate class the lowest GPA accepted from the accumulated total of these prerequisite courses was a 3.8 on a 4.0 scale. Basically, nurses must achieve an A average in the same courses physicians do to sit for their MCAT.

    Once accepted into an undergraduate nursing program students complete entire semester rotations in pediatrics, OB, psych, general medicine, community health, and a subspecialty of their choice. In addition, they are enrolled in courses in all of these areas which actually teach them..medicine. Is this shocking? While they are not learning to carry out the interventions that physicians do, they must know everything about how they are preformed, normal outcomes, and adverse outcomes. This is because one of the myriad roles of nurses includes early intervention. Therefore, it is essential that nurses understand the medical foundation and pathophysiology behind conditions found in the aforementioned fields of medicine. For instance, did you know that RN students also spend a great deal of their lives slumped over the same textbooks their physician peers did during their medical training. Did you also know that they have assessment labs and perform head-to-toe patient assessments and histories before they even attend graduate school?

    Of note, NPs are typically specialized. This means that all of their graduate education is focused on their specific population which allows for a more condensed curriculum.

    Also, did you know that NPs complete more pharmacology courses (on average 2 years), more research courses (on average one undergraduate and one graduate level research class), and more statistics/data management courses than the average MD?

    Finally, it is not appropriate to compare a new attending to a new graduate NP. This is not comparing apples to apples. Most NP orientations are over the course of several years where they complete a certain number of procedures and interventions with an experienced provider before they practice on their own. If you would like to compare a MD as a new attending practicing in a specialized field for the first time to a NP with 5 years of experiance, you then would be comparing two of a kind. Although, NPs do practice under the theoretical foundation that people are whole beings and not simply one diagnosis after another, you would see the practice of experienced NPs and their MD colleagues to be incredibly similar.

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  20. Such a prejudiced article. NP did start with a nursing background, but not “just a nurse”. She took a different path of becoming a Healthcare provider and NP and RN are two separate employees at the hospital. RN is a nurse who works under supervision of NP. Pa, NP and MD are the healthcare providers who started off with different ways of education. Maybe an insecure MD can call NP just a nurse, but she is on the same level in healthcare as MD.

  21. This article is so biased! Just a Nurse ! Wow. A NP can do as much as a primary M\D.It changes from state to state on collaboration vs independence. A Rn is a nurse and does not need direction under a doctor. Rn s are a nurse and function under their own licence.The person writing this article does not know what they are talking about.A medical doctor does have a slight more amount of education and they are under a different board,however in primary setting there is little difference.Both Rn s and NP have suitable education and ,by the way do not need a medical doctor looking over their shoulder to perform their job.
    Doctors are upset that another profession can give care and perform functions like they can.This article is another attempt to blur the lines for the public that a medical doctor is far superior than a NP and nurse are just the help!!! Come on get a clue!!

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