Over the past decade, a surge of nurse practitioners has invaded the health scene as hospitals, medical centers, and clinics struggle to keep up with mounting patient caseloads. While patients seem confused at first about being treated by a nurse, the word has spread quickly about the differences between nurse practitioners (NPs) and doctors — mainly about the differences in health care style. But, there are other differences, too, such as the level of education, the salaries, and the perceptions about health care in general that have pervaded current trends in health care. Overall responsibilities of nurse practitioners will only increase as the population ages, and as more people are treated for their illnesses outside hospital environments. With a decrease in general practitioners, the NP may take that place, especially with the introduction of doctoral degrees in the NP program.
Differences in Education
According to the American Medical Association (AMA), the steps to becoming a physician take over a decade:
- First, the medical student must complete a BS or BA degree, usually with a strong emphasis on basic sciences, such as biology, chemistry, and physics.
- Four years of medical school follows to earn a medical degree.
- Newly graduated MDs then enter into a residency program that is three to seven years or more of professional training under the supervision of senior physician educators. The length of residency training varies depending on the medical specialty chosen: family practice, internal medicine, and pediatrics, for example, require three years of training; general surgery requires five years.
- Finally, many physicians complete one to three years of additional training in a subspecialty. This is an option for some doctors who want to become highly specialized in a particular field.
Individuals who want to become nurse practitioners must take the following steps:
- First, obtain an undergraduate degree in nursing and obtain licensure to practice as a Registered Nurse (RN).
- The reason you need a bachelor’s degree is because you then must go on to earn a master’s degree in a subspecialty such as neonatal care, pediatrics, mental health, adult care, family care and acute care. The time frame for the master’s degree usually is two years. You also can find BSN-to-MSN programs that allow you to move forward in your studies quickly.
- Besides the master’s degree requirement, all NPs depending on their specialties must be certified by either the American Nurses Credentialing Center, the American Academy of Nurse Practitioners Certifying Board, or the National Certification Corp. before being licensed by a state.
- You can go on to earn a doctoral degree in nursing now (DNP, or Doctor of Nurse Practice), and this degree allows the nurse practitioner to prescribe medications. As of the end of 2011, 154 DNP programs were operating in the U.S.
Although physicians routinely receive 15,000 to 17,000 more training hours than DNPs, the nurse practitioner with a doctoral degree is needed in today’s health care environment. The Association of American Medical Colleges (AAMC) says that, at current graduation and training rates, the U.S. could face a shortage of up to 150,000 physicians in the next 15 years, and NPs can fill that gap in primary care practices.
Differences in Style
There is a difference in style between medical care and nursing care models in health care. The medical model tends to focus on diagnosis and treatment of a disease. The nursing model of health care incorporates the treatment of the human response to disease and emphasizes disease prevention.
Compared to the medical model of care, the nursing model of care tends to be more holistic. The ideal in nursing is to foster the patient’s role in treatment and prevention through educational movements, home healthcare, improved personal hygiene and food handling, and working for better hospital conditions to reflect better the psychosocial aspects of illness.
Medicine has elected an approach that underscores curing as a response to the occurrence of a disease, with the hospital as the center of best medicine. For example, a doctor may prescribe pills for a patient with high blood pressure; however, a nurse may dig deeper to learn the causes of that high blood pressure and help to eliminate those issues.
Studies have suggested that the quality of primary care delivered by NPs is no different than that delivered by physicians; however, according to one randomized trial, “these studies did not measure nurse practitioner practices that had the same degree of independence as the comparison physician practices, nor did previous studies provide direct comparison of outcomes for patients with nurse practitioner or physician providers.”
State Regulation and Salaries
As the NP practice grows, the regulations probably will change. Currently, the nursing practice is independently regulated by states, and sometimes significant variations are evident. In some states, NPs are blocked from prescribing medication, or can practice only under a collaborative agreement with a physician or with a health facility. The growth of the DNP practice likely will change how medications are offered as well, considering the problems facing the health care community.
In many rural areas, NPs have provided primary care where communities are underserved by physicians. Doctor shortages, along with hiring caps in place within many hospitals demands the use of NPs when salaries are considered. Primary care physicians, or general practitioners (GPs), make an average annual salary of $191,401, but they also are faced with rising medical school costs. Because of this issue alone, the GP is becoming a dying breed. Specialization not only pays more, but many doctors find specialization more interesting.
While NPs don’t earn as much as physicians, they are in the upper tier of nursing salaries. A recent CNNMoney report showed the NP ranking as fourth in the top 50 jobs in health care, with an average annual salary of $85,200, with top pay of $113,000. Although this salary may not seem fair when compared to GP practice, that compensation may rise as the NP or DNP is needed to fill roles once occupied by the GP.
A Different Health Care Scene
The trends in health care provided by physicians and nurses are changing rapidly. The rise in DNP programs and graduates that will come on the scene within the next five years will make a difference in how many patients are treated. A focus on preventive care and holistic healing can belong to the NP. The trend in physician care, or the medical model, is toward specialization. While the role change might be confusing for some patients to start, the realization that doctors and hospitals are for emergencies and NPs are for health may be a healthier way to view the future of health care.