Opinion: MD says nurse practitioners should work independently

The influx of states expanding the medical reach of nurse practitioners has spurred a backlash from many physicians. In an opinion piece appearing in STAT, Vinay Prasad, MD, assistant professor of medicine at the Oregon Health and Sciences University in Portland, makes a case for the expanding role of nurse practitioners.

In the STAT piece, Dr. Prasad states that the critics against nurse practitioner autonomy often cite the NP's lack of expertise regarding matters of disease pathology as a serious hindrance in their ability to care for patients.

On these criticisms, Dr. Prasad writes, "Doctors, they argue, have trained for years in the pathology of disease, the little cellular changes that drive illness (or at least that drive our latest models of it), while nurses seldom ruminate on these details. Of course, I know many doctors who have long forgotten most of this pathology. But even if this were true, I am not sure that a more intimate understanding of the biology of disease inherently leads to better decisions for patients."

Dr. Prasad goes on to argue that an overemphasis on disease pathology can sometimes spur overconfidence in therapies that are not guaranteed to work. These confidences can lead to physicians not offering a strong set of alternative therapies.

Dr. Prasad asserts that excellent physicians and excellent nurse practitioners should both be allowed to thrive in the care continuum. He writes, "When it comes to caring for my patients or the people I love, I would eagerly trade three mediocre physicians for one excellent nurse practitioner."

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