How NP growth is changing healthcare hierarchies

As nurse practitioners surge to 385,000 strong in the U.S., the growing profession is establishing itself as an even more prominent role in healthcare hierarchies. Simultaneously, the American Medical Association anticipates a looming shortage of 100,000 physicians in the next decade. So how will the growth of one and the shrinking of the other influence hospital dynamics?

Harvard Medical School researchers found that 25% of U.S. health visits are conducted by a non-physician. During those visits, physicians and nurse practitioners agree that patients should be aware of who they are receiving care from and what their credentials are. 

In tandem, nurse practitioners and physicians do receive some similar training, but NP's do not go to medical school and typically complete a practicum rather than residency. Medical school is much more intensive in both training and duration, however, NPs can also end up with doctoral-level education — and that accolade is where the heart of the debate lies.  

Inside hospital hierarchies

The hotly contested issue of whether advanced practice nurses with doctoral-level education should get to use the title "Dr." when practicing has drawn advocacy on both sides of the issue and even lawsuits

But inside hospital walls, the shifting landscape of the profession is seen by some as beneficial to reshaping workplace dynamics, and the topic of debated titles falls by the wayside. 

"When we think about the traditional hierarchy of healthcare where the physician is at the top and everyone else is underneath a physician, I think when the nurse practitioner role is a member of the healthcare leadership team, it has helped create more comfort with the bedside nurses," Ceonne Houston-Raasikh, DNP, MSN, RN, chief nursing officer at the Keck Hospital of USC told Becker's. "But I think the greatest impact on changing that hierarchy has been the way we train our physicians. Today, our physicians are trained to work as a member of a healthcare team. They're coming out of medical school with the understanding that it's not all about the physician, that you need every member of the healthcare team fully participating to improve outcomes for our patients."

In other instances, the title discussion does come up during work, but more often due to patient education. Katie Anderson, APRN, FNP, MSN, RN, a provider with Elite Healthcare in Cross Road, Texas, that helped establish the family care clinic with Zivian Health, said she often corrects patients about her title. 

"The public's general understanding doesn't always keep up with these rapid changes, and I feel that it is crucial always to clarify that we are not medical doctors. In fact, I often find myself correcting my patients when they call me 'doctor,'" she said. "Clarity in healthcare roles is essential for delivering the best patient care… In the same way we empower our patients with knowledge about their health, we should always strive to consistently provide education regarding our distinct backgrounds, education and roles within the healthcare community."

Filling widening gaps in care

Others say that in many ways, while existing hospital hierarchies are dying, in the meantime they can still be stifling and limit NPs from practicing at the top of their license.

"The impact of more NPs in the workforce, in leadership and in C-suite positions, and the broader inclusion of NPs and other providers from multiple healthcare disciplines as voting members on hospital and health system boards has moved us closer to our goals," Stephen Ferrara, DNP, president of the American Association of Nurse Practitioners told Becker's. "However, more work needs to be done, as outdated hierarchical models that fail patients and artificially constrain the full participation of all healthcare providers still dominate too many facets of healthcare…. Healthcare improves when we're all at the table while working at the top of our education and clinical preparation." 

But regardless of titles or hierarchies, research on patient outcomes has found that those who receive care from nurse practitioners experience fewer unnecessary hospital readmissions and improved satisfaction, according to the AANP. 

These healthcare providers are also more likely to practice in rural and smaller community settings than physicians, which when given autonomy to practice can fill gaps in care access, research has shown. 

And ultimately, filling those gaps is what nurse practitioners and physicians aim to do.

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