Saturday, January 29, 2011

We're Not Going Away

As I browsed my twitter account today, I came across a post that mentioned me and was curious, so I clicked on the link and found that I couldn't just sit by and let his post stand alone without a rebuttal.  Dr. Wes was confused as to why I was a "self-procalimed" hospitalist NP.

You see, I work in the hospital setting with a group of physicians that care for inpatients when their primary care providers choose not to come there. This group of providers is called "Hospitalists." Therefore, I am a Nurse Practitioner Hospitalist. As far as I know, there is not a copyright on this title or the title of "doctor" or "physician." Do I introduce myself as a hospitalist? No (because patients still have no idea what that is). I always say I'm a nurse practitioner (most do know what that is in our area, as we make up the majority of primary care providers in our community), and I tell them what I do. Depending on the patient, I may say " I work with the hospitalist program," or I may just say "I work with the hospital's doctors' service (because let's admit it, everyone still calls their provider a doctor whether they are or not), we take care of you while you are in the hospital, and we communicate back to your doctor or nurse practitioner what happens while you are here." I tell them the name of the physician I'm working with that day, and that we work as a team. This description of what I do has not caused any confusion among my patients, although clearly it's the quick-to-remind-me "real doctors" who are confused.

Initially, I took it personally (for all NPs). Then I read a few more of his blog posts, and realized I am just small beans in the huge pot of paranoia stew. To add fuel to the fire in my butt, he sent me a message that said "No doubt you're great, and relatively cheap, for your hospital-employer." I had to tell him that the hospital does not employ me, a group of physicians does, and of course it's all about the money. In turn, I asked how he would feel if he were referred to as "over-priced." No response.

In another tweet, he said it "devalues our degrees and hospital-employers are encouraging this. Doctors should take notice." Really? My employer is a physician owned group of providers who provide services to hospitals (not hospital-owned).  The hospital pays the same amount monthly for our services, so obviously, again, it is about the money as I make one half the salary of my doctor/supervising physicians, making it possible to have more staff available for the same price. However, they have a job much more difficult than mine, including seeing and signing all my charts, seeing the critical care patients, and taking call 24/7.  Our company, and many others, realize the quality of care they get for the price with NPs, and when they pair us up with a quality physician, they get more bang for their buck. Insurance companies reimburse for our services at 85 percent of the physician fee, we work under our own license (not the physician's,) we cost half the price of a physician, so anyone with any financial accumen at all would see the benefit in this.

This was the second physician I've been in contact with recently who needed a little education. One of the orthopedic docs I work with recently said to me, when he was looking for someone to do rounds and help in surgery (and he thought he needed a PA, but I suggested one of our NPs who worked in acute care), and he said "nurse practitioner, that's like LPN, right?" Seriously.

This article is a great complilation of just a few of the studies that have been done to demonstrate NP competency and quality of care, as well as patient satisfaction (which is the ultimate quality indicator).

It really doesn't have to be "us against them," but sometimes it sure does seem that way.

1 comment:

  1. Bravo! You are right on the money; no pun intended! It seems to me that the physicians that are comfortable with their role and position within health care are the most supportive of NPs and advanced practice nursing roles in general. Unfortunately, we still have to 'work' with the physicians that do not understand or appreciate the value of collaborative medicine and working as a team.