Let’s Settle This: Do Nurse Practitioners and Physicians Provide Equal Care?

Patients, friends, academics, politicians, and everyone in between deserve to know the answer to an infamous question: do nurse practitioners provide care equal to that of physicians? Come to think of it… what is the difference between nurse practitioners and physicians? There seems to be more than enough misinformation out there to lead to generations of confusion. The purpose of the article is to give you the right research to settle the debate once and for all.

What is a physician?

The title physician encompasses a variety of disciplines, but for this article, we will only include doctors of medicine (MD) and doctors of osteopathy (DO). These are the people you typically think of when you “go to the doctor.” They are expert clinicians educated to assess, diagnose and treat medical conditions. They can prescribe medication, refer you to physical therapy, and determine your disability status.

They typically earn a bachelor’s degree in a general science prior to attending medical school. During medical school, they undergo extensive education in pathophysiology, microbiology, epidemiology, and pharmacology while completing patient simulations and rigorous clinical rotations. These physicians specialize and subspecialize in a variety of fields from pediatrics to psychiatry to gerontology. After medical school, physicians usually complete a paid residency in their area of specialty.

What is a nurse practitioner?

What is the difference between nurse practitioners and physicians? Nurse practitioners are expert clinicians who are educated to assess, diagnose, and treat medical conditions. They can prescribe medication, refer you to physical therapy, and determine your disability status. Their philosophy of care is holistic and emphasizes disease prevention and health promotion.

Nurse practitioners typically earn a bachelor’s degree in nursing prior to attending nurse practitioner school.  During nurse practitioner school, they undergo extensive education in pathophysiology, microbiology, epidemiology, and pharmacology while completing patient simulations and rigorous clinical rotations. Nurse practitioners specialize and subspecialize in a variety of fields from pediatrics to psychiatry to gerontology. After nurse practitioner school, they sometimes complete a paid residency in their area of specialty; however, this is not a requirement.

What do you mean by “equal care?”

Equal care means that regardless of who provides the care, the patient received the same diagnosis and treatment, experiences the same or similar health outcomes, and feels satisfied with the care provided.

With the emergence of the nurse practitioner role, physicians felt the pressure of market competition. They raised concerns about safety, effectiveness, and patient satisfaction. And rightfully so. Patients have the right to the best care at all time. These questions arose:

• Nurse practitioners are not physicians, so are they able to provide health care safely?
• Nurse practitioners are not physicians, so are they diagnosing and treating medical conditions accurately?
• Nurse practitioners are not physicians, so will patients be satisfied with their care?

To address these very important questions, researchers began comparing the care provided by physicians with the care provided by nurse practitioners. They compared the health outcomes of the patients seen by physicians with the health outcomes of the patients seen by nurse practitioners. The question they sought to answer: do nurse practitioners provide patient care equal to that of physicians?

What does the research say?

Research examining nurse practitioner effectiveness began in 1986 when the United States Office of Technology Assessment compared the practice patterns of nurse practitioners with physicians. This study concluded that nurse practitioners performed as well as physicians in all areas of primary care delivery and patient outcomes.

Since this groundbreaking research, study after study has reached similar conclusions. A 2011systematic review of all nurse practitioner effectiveness research found that nurse practitioners provide effective, high-quality care with outcomes similar or superior to physicians. This quantitative study synthesized the findings of all research conducted on this topic for 18 years. The authors of the study included both nurse practitioners and physicians.

Furthermore, additional research has demonstrated that nurse practitioners actually lower healthcare costs, increase patient satisfaction, and offer a solution to the current and ever-worsening shortage of qualified primary care providers.

For a complete annotated bibliography of all research comparing the care provided by physicians with the care provided by nurse practitioners please see the American Association of Nurse Practitioners’ paper titled Quality of Nurse Practitioner Practice.

Who supports nurse practitioners?

The Institute of Medicine and the Robert Wood Johnson Foundation are long-time supporters of nurse practitioners. They advocate that nurse practitioners provide patient care equal to the care provided by their physician colleagues.

In their 2010 report, The Future of Nursing, Leading Change, Advancing Health, the Institute of Medicine asserted that states across the country should remove legal barriers, often imposed by physicians, that nurse practitioners from practicing to the full extent of their education. Shortly thereafter, the Robert Wood Johnson Foundation founded the Campaign for Action, which advocates for nurse practitioner independent practice in the United States.

More recently, the United States Federal Trade Commission (FTC) published their perspective on the nurse practitioner and physician debate. In their paper titled Competition and the Regulation of Advanced Practice Nurses, the FTC stated that when physicians attempt to control nurse practitioner’s ability to practice, they are actually impeding quality competition, raising healthcare prices for patients, and diminishing access to care.

Why does confusion persist?

I’ve met my fair share of registered nurses who disavow the research and insist that physicians provide better patient care than nurse practitioners. If nurses remain confused, I can only imagine how confusing the topic must be to patients and the public.
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I think some of the confusion arises from how few people understand who nurse practitioners are and what they do. Many patients “go to the doctor” never realizing that a nurse practitioner assessed their symptoms, diagnosed their condition, and prescribed their treatment. Often, patients assume this person in a white lab coat is a physician.

Even other clinicians do not understand nurse practitioners. Physical therapists who often need a “doctor’s referral” to provide treatment to their patients commonly do not understand that this referral is actually coming from a nurse practitioner. For all the nurse practitioners reading this article, you must ensure your patients and your colleagues know who you are; otherwise, how will they tell the world how awesome you are?

The good news is, the confusion is dissipating. Nurse practitioners are showing up on the news, TV shows, and movies. It’s becoming a highly sought after career. Legislation is passing across the country that enables nurse practitioners to practice freely. Progress is being made, slowly but surely.

I originally wrote this article for Health eCareers. Read the article on their blog, and check out the latest nurse practitioner jobs and salary information on their website. ​