s/o Do you ask for a doctor instead of a nurse practitioner?

[Anonymous]

Sorry, but you are wrong. A doc can do a crappy residency at a good hospital or a good one at a smaller hospital. The interns are idiots and most of them think they're infallible, and they rarely change their minds.

There are good and bad nps----I'd see one for routine well child care and I see one for routine illness. That's what they're supposed to do: manage more or less routine care in a stable population. Your obesity, high blood pressure or early CHF are routine. When you are sicker, then you need a md.

[Anonymous]

I have no problem with NPs. In some instances, I prefer them. If it's routine, I'm perfectly happy to see an NP.

I know OP's post was about a pediatric office, but I did recently have an experience at my OB/Gyn practice that has changed my perspective a little. An NP did my Mirena insertion and follow-up check. She missed a problem with the Mirena at the follow-up that I think my regular doctor would have caught. So, fair or not, I would prefer to have a doctor perform any procedures.

[Anonymous]

I always opt for a doctor. Fair or not, I feel like I'm not getting the "real thing" when I see a NP. And unlike PP's my DD's pediatrician's office has a NP who is incredibly unfriendly and unpleasant, so in that case I always opt for the doctors.

[Anonymous]

Anonymous wrote:I always ask to see a doctor. If I am going to take the time to get over there I want to see a doctor. It has been shown that in healthy patient populations who are also well educated, there is little difference in outcome. However in people who are prone to severe illness and lower SES a doctor is warranted. But guess where NPs practice most?

OK- enough with the ill informed commentary...please know that studies have been conducted in populations with higher risk profiles with good outcomes. NPs practice most in these areas because that is where the need is. My grad program encouraged us to provide care to underserved populations and that is how I have chosen to dedicate my career. Please see the following studies:

From JAMA:
Primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial.
http://www.ncbi.nlm.nih.gov/pubmed/10632281
CONCLUSIONS: In an ambulatory care situation in which patients were randomly assigned to either nurse practitioners or physicians, and where nurse practitioners had the same authority, responsibilities, productivity and administrative requirements, and patient population as primary care physicians, patients' outcomes were comparable.

From Medical Care (2 year f/u to JAMA study):
Primary care outcomes in patients treated by nurse practitioners or physicians: two-year follow-up.
http://www.ncbi.nlm.nih.gov/pubmed/15358970
The results are consistent with the 6-month findings and with a growing body of evidence that the quality of primary care delivered by nurse practitioners is equivalent to that by physicians.

From the New England Journal of Medicine:
Telephone management of acute pediatric illnesses.
http://www.ncbi.nlm.nih.gov/pubmed/619242
Abstract:To evaluate the telephone management of five common acute pediatric problems, a "programmed mother" made unidentified cells to five pediatric nurse practitioners, 28 pediatric house officers and 23 pediatricians in practice. Calls were tape recorded and scored for history taking, disposition and interviewing skill. Nurse practitioners averaged 79.6 per cent of the total possible theoretical score for history taking, house officers 69.1 per cent, and practicing pediatricians 52.6 per cent (P less than 0.001). For disposition, nurse practitioners averaged 71.1 per cent of the maximum score, in contrast to 60.1 per cent for house officers and 58.9 per cent for practicing pediatricians. Similarly, nurse practitioners had significantly higher (P less than 0.001) scores for interviewing skills. No significant differences were found among house officers in the first, second and third years in history taking, disposition or interviewing skills. We conclude that pediatric nurse practitioners manage common pediatric problems by telephone better than house officers or practicing pediatricians and that better training for this aspect of practice is needed.


From The European Journal of Cardiothoracic Surgery:
Advanced care nurse practitioners can safely provide sole resident cover for level three patients: impact on outcomes, cost and work patterns in a cardiac surgery programme
http://www.ncbi.nlm.nih.gov/pubmed/22875555
CONCLUSIONS: With adequate training and appropriate support, resident NPs can provide a safe, sustainable alternative to traditional staffing models of cardiac intensive care. Training opportunities for junior surgeons increased and costs were reduced.

From Pediatrics:
A controlled trial of nurse practitioners in neonatal intensive care.
http://www.ncbi.nlm.nih.gov/pubmed/8951267
CONCLUSIONS: CNS/NP and resident teams are similar with respect to all tested measures of performance. These results support the use of CNS/NPs as an alternative to pediatric residents in delivering care to critically ill neonates.

From Archives of Pediatric & Adolescent Medicine:
Comparison of neonatal nurse practitioners' and pediatric residents' care of extremely low-birth-weight infants.
http://www.ncbi.nlm.nih.gov/pubmed/11074854
CONCLUSION: Neonatal nurse practitioners and pediatric residents provided comparable patient care to extremely low-birth-weight infants, with similar outcomes and similar charges.

From the British Journal of Dermatology:
A randomized controlled trial in children with eczema: nurse practitioner vs. dermatologist.
http://www.ncbi.nlm.nih.gov/pubmed/19849695
Conclusions The level of care provided by a nurse practitioner in terms of the improvement in the eczema severity and the quality of life outcomes was comparable with that provided by a dermatologist. In addition, the parents were more satisfied with the care that was provided by a nurse practitioner.

And on and on and on...

[Anonymous]

At Capitol Medical Group, the NPs are the best for practical advice. Would ALWAYS choose one vs. MD when kid sick with routine issue.

[Anonymous]

22:54 again- and I don't mean to say that people should want to go to a NP over a MD- it should be whatever you are most comfortable with but I just wanted to cite some of the many, many studies that have been done looking at this issue. People can post all of the anecdotes that they wish to provide but the evidence shows that NPs provide safe care (and many studies show higher patient satisfaction to boot)

[Anonymous]

An NP masters program is 18 MONTHS and at many institutions can be completed online. A student can enter this type of program after completing a 1 year accelerated RN BSN program.

From the Georgetown website:

"Nursing@Georgetown’s online FNP program enables you to:
Earn your Master of Science in Nursing degree in 18 months as a full-time student"

Contrast that with medical school and residency with is 7 years total for internal medical or family practice.

[Anonymous]

My ped office confirms with me if I'm ok with seeing an LNP for sick visits. I do prefer to see the LNP for well visits though, much better bedside manner, more patient with my active boys.

[Anonymous]

I think peds are worthless drug pushers, and I avoid doctors unless hell is knocking. I would give a NP more respect bc I don't judge you as assholes.

Oh and male obgyns are perverts.