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Why Nurse Practitioners Should Not Do Primary Care Without Physician Oversight

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Why Nurse Practitioners Should Not Do Primary Care Without Physician Oversight

“She said my back pain was caused by micro kidney stones.”

So said my newest patient after her previous primary care provider, a nurse practitioner retired.

“Micro kidney stones?”

I didn’t know what else to say. Having practiced as a board certified primary care doctor for a decade, I’d never even heard this term.

Nurses Are Not Doctors

So the NY Times opinion piece that “Nurses Are Not Doctors“, penned by Dr. Sandeep Jauhar, author of Doctored: The Disillusionment of an American Physician, resonated with me. The fact that 17 states have legislated nurse practitioners the right to practice primary care medicine without physician oversight is very worrisome. There is a primary care crisis. We do need more primary care providers. Though nurse practitioners can fulfill some of the demand they cannot do so without doctor oversight. Though on paper it seems like what primary care doctors do is easy, in fact when digging a little deeper, one finds out these two specialties are not the same though some states view them as such.

It boils down to training. Primary care is a cognitively challenging specialty. The amount of training doctors receive is far greater than that of nurse practitioners.

As Malcolm Gladwell, best-selling author of Outliers: The Story of Success noted in a 2013 New Yorker piece regarding the 10,000 hours of deliberate practice  observation -

  • Forty years ago, in a paper in American Scientist, Herbert Simon and William Chase drew one of the most famous conclusions in the study of expertise:
    There are no instant experts in chess—certainly no instant masters or grandmasters. There appears not to be on record any case (including Bobby Fischer) where a person reached grandmaster level with less than about a decade’s intense preoccupation with the game. We would estimate, very roughly, that a master has spent perhaps 10,000 to 50,000 hours staring at chess positions…


  • But the ten-thousand-hour research reminds us that “the closer psychologists look at the careers of the gifted, the smaller the role innate talent seems to play and the bigger the role preparation seems to play.” In cognitively demanding fields, there are no naturals. Nobody walks into an operating room, straight out of a surgical rotation, and does world-class neurosurgery.

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