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

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[quote=Anonymous][quote=Anonymous]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?[/quote]

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.
[url]http://www.ncbi.nlm.nih.gov/pubmed/10632281[/url]
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.
[url]http://www.ncbi.nlm.nih.gov/pubmed/15358970[/url]
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.
[url]http://www.ncbi.nlm.nih.gov/pubmed/619242[/url]
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
[url]http://www.ncbi.nlm.nih.gov/pubmed/22875555[/url] 
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. 
[url]http://www.ncbi.nlm.nih.gov/pubmed/8951267[/url]
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.
[url]http://www.ncbi.nlm.nih.gov/pubmed/11074854[/url]
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.
[url]http://www.ncbi.nlm.nih.gov/pubmed/19849695[/url]
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...[/quote]

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