What do you think of seeing nurse practitioners?

[CJ2008]

More and more these days I show up to what I thought was going to be a doctor's appointment only to find I'm not seeing the doctor, but a nurse practitioner.

Just now, I got a call from the gynecologist's office where I have an appointment next week to tell me that if I want to see the doctor I need to wait until August...otherwise I can keep the appointment but see a nurse practitioner.

I said I'll wait...

But I'm not sure that there's a need to...it's almost my default response most of the time...but I'd like to have a good reason for doing one way or another.

What do you do? Do you care about seeing an actual doctor versus a nurse practitioner? Does it depend on the reason for your visit?

 

[missy]

It depends. For a routine procedure an NP is totally capable and competent. Nurse practitioners run the gamut just like doctors do. There are some very capable ones whom I would trust and others not so good. For a more difficult assessment I would prefer an MD vs NP but for something straightforward that they have plenty of experience with I would have no problem seeing an NP.

 

[Kelinas]

Depends.
For not so urgent, general care : I don't mind seeing NPs

Anything that deals with neurological issues: definitely a specialist MD.
They tried to make me see a NP instead of my usual Dr.
The idiot prescribed me a medication that would have given me a stroke had it mixed with the meds I was already on.
Yay for medical professionals who don't read patients charts .

Never again.
But regular appointments? No problem.

 

[packrat]

I used to always see an NP or ARNP, never saw the Dr. When we decided to try for a baby, that's when I started seeing a Dr. Now I only see her for my annual. Mostly that is b/c I worked there and the ARNP's were my coworkers so I didn't like the idea of them seeing my bits. We see the three ARNP's in the office for everything, otherwise. It's easier to get in to see them and you don't have to wait as long. Dr. does OB and has to take on call in the ER, so there's times it's a looooong wait to see her if you have an appt w/her. They all have access to our EMR's so they all have the same info to look at. If they have a question on anything, they'll go ask her, but that is rare.

 

[CJ2008]

Thanks all.

And it is true that just like with doctors there are great nurse practitioners, and not so great ones...ETA: Kelinas I would not AT ALL be surprised if you had been prescribed the wrong med by a doctor, either...I feel like most of the time, they don't take the time to understand your whole history.

It sounds like you use the same general criteria I do...I think what influenced me to see the doctor also is because I'm a new patient and I actually want to meet the doctor behind the practice...maybe going forward I might be OK seeing the nurse practitioner for the yearly checkup.

 

[JulieN]

For anything routine, it is fine.

 

[AprilBaby]

I would have no problem seeing the nurse practitioner. I wonder if you get charged less. You should.

 

[Kelinas]

Yep. I feel that I'm the best advocate for myself. I make sure that the Dr knows what I'm on.

And I never. Ever. Eveeeer take any medication without doing my research first.

 

[iLander]

I had both my children with Certified nurse practitioner midwives.

They took care of me and my children from prenatal, through both birthing experiences, and after the births. Also, routine gyno for years after. Never a problem or issue.

I found them to be extremely thorough, knowledgeable, and helpful.

I much prefer them, myself. They took their time, I never felt rushed like I have with some doctors.

 

[CJ2008]

Yep. I feel that I'm the best advocate for myself. I make sure that the Dr knows what I'm on.

And I never. Ever. Eveeeer take any medication without doing my research first.

Same here, Kelinas.

And I've come to the point where I take almost NOTHING my dermatologist recommends - it seems that if it makes the skin look good, they care about nothing else. Now I *know* they're dermatologists, and that's what they do - make the skin look good - but they don't seem to care about parabens, etc. (at least not the one I go to now). She recommended Metrogel for me, I picked it up and saw it was full of parabens (I can't return it of course because it's a prescription so $40 down the drain) ...when I told her I didn't want to use it because of that she said the only reason to avoid parabens is if I'm allergic to them. Same thing with her Minoxidil recommendation - I asked her if there were any potential side effects and she said no...but when I researched it there are plenty of potential side effects...I realize that if she's recommending something to me it's because she feels the benefits outweigh the risks...but at least give me the real deal/details and then let me decide...

 

[CJ2008]

I much prefer them, myself. They took their time, I never felt rushed like I have with some doctors.

I did find this with *one* particular nurse practitioner - she really took her time - I liked her so much and trusted her so much I always did exactly as she recommended (vitamin B12 shots, blood tests every 3 months, whatever supplements she recommended).

Every other nurse practitioner my experience was no different / better than with a doctor - mostly lukewarm - none of them stood out to me as really being thorough and answering whatever questions, etc.

 

[katharath]

I've had some excellent doctors and some truly awful ones.

My favorite health care provider was a NP. She was my primary care provider for 8 years, until she recently moved. She was by far the most thorough and knowledgable provider I've ever used; far better than any doctor I've used (with the exception being specialists). For my everyday and general needs, though, she was the best. I was really upset when she moved! I've since begun using a new NP. I tried out two new doctors before finding this NP, and she was far better than the docs I tried first. I am on several maintenance/daily meds, so it's really important to me to have a reliable, good provider. I've seen her a few times now, and I'm confident that she will work out as my new provider.

It just depends on the quality of the person. I don't care at all if my provider isn't a doctor, I'm fine with using a NP, as long as they're excellent (and mine have been).

 

[Kelinas]

Yep. I feel that I'm the best advocate for myself. I make sure that the Dr knows what I'm on.

And I never. Ever. Eveeeer take any medication without doing my research first.

Same here, Kelinas.

And I've come to the point where I take almost NOTHING my dermatologist recommends - it seems that if it makes the skin look good, they care about nothing else. Now I *know* they're dermatologists, and that's what they do - make the skin look good - but they don't seem to care about parabens, etc. (at least not the one I go to now). She recommended Metrogel for me, I picked it up and saw it was full of parabens (I can't return it of course because it's a prescription so $40 down the drain) ...when I told her I didn't want to use it because of that she said the only reason to avoid parabens is if I'm allergic to them. Same thing with her Minoxidil recommendation - I asked her if there were any potential side effects and she said no...but when I researched it there are plenty of potential side effects...I realize that if she's recommending something to me it's because she feels the benefits outweigh the risks...but at least give me the real deal/details and then let me decide...

One of my dermatologist in the past (military drs overseas. You don't get to choose) went over my file...
Med #1? Tried it. Med #2? Tried it. Med #3?tried it.
He then sighed
Said he'd be back.

Comes back with a medication that has been known to cause skin cancer.
sighs again and tells me that this is the only medication that he can give me, and to personally weigh the pros and cons.

Hmmm itchy dyshidrotic eczema or skin cancer?
Decisions decisions.

 

[tyty333]

I like to see NPs for anything normal. They seem to spend more time with me and seem to be a little more patient. I would NOT like to
think I had an appointment with a Doc and show to find out its a PA or NP.

To get to some of the specialist Drs. in my area you have to see their PA first. The PA gets all the information then later you get an
appointment with the Dr. I guess they want to make sure that you truly need the specialist. A lot of the specialist in my area are
very busy.

 

[Dancing Fire]

What level of medical education would one needed to become a NP?

 

[Sky56]

OK with them.

 

[lknvrb4]

I went from incompetent doc who would not really listen to me to a very wonderful NP. My NP is a woman and also a runner so she understands what my body goes through and she can relate to me. She gave me helpful advice to solve a problem I was having that my doc just blew off.

 

[missy]

What level of medical education would one needed to become a NP?

Hi DF, you have to become a registered nurse first and then go on to advanced training. It probably differs somewhat between states but here are 2 helpful links.

http://education-portal.com/nurse_practitioner_education_requirements.html

http://www.innerbody.com/careers-in-health/how-to-become-a-nurse-practitioner.html

Nurse practitioners must first earn a bachelor’s degree in nursing (BSN) from an accredited training program. This takes about four years of full-time study and requires both classroom and clinical learning.

Many BSN programs are tailored to the needs of working students. Bridge programs help nurses who hold an associate degree (ASN) pursue a bachelor’s degree or graduate-level study. Students who have earned a four-year degree in a non-nursing field should look into an accelerated BSN program.

After obtaining a bachelor’s degree, nurse practitioner candidates must complete an additional two to six years of study to earn a master’s degree in nursing (MSN) or Doctorate of Nursing Practice (DNP). Graduate programs include in-depth courses in anatomy, diagnosis, pharmacology and medical ethics as well as extensive clinical training. During this phase, students begin to focus on a specialty such as:

Women’s health
Family and primary care
Acute care
Oncology
Geriatrics
Pediatrics
Psychiatry
Many graduate schools require nurse practitioner candidates to have a few years of experience as a registered nurse (RN). The National League for Nursing Accrediting Commission and American Association of Colleges of Nursing list accredited programs on their websites.

 

[ame]

I actually prefer them in most cases. Easier to get in with, they take their time, and in many cases, I've found them more competent.

At my derm you alternate seeing the dr and the nurse practitioner. I find the NP more thorough in my skin exams. She gets ALLLLL up in there, even checking your private parts like an OB would if she knows you've been in a tanning bed even one time (and I have.)

At my OB, you see the NP every other time as well and she consults the Dr at your appointment usually as well, so technically you see both. Or at least for me since I've had cervical cells removed more than once. I have two doctors at the practice I will regularly see, one more specialized in the cervical situation, but I've been happy with everyone in that practice except one dr who left bec she was a righteous c-word.

 

[Dancing Fire]

What level of medical education would one needed to become a NP?

Hi DF, you have to become a registered nurse first and then go on to advanced training. It probably differs somewhat between states but here are 2 helpful links.

http://education-portal.com/nurse_practitioner_education_requirements.html

http://www.innerbody.com/careers-in-health/how-to-become-a-nurse-practitioner.html

[/quote]


Thanks Missy..

 

[Circe]

I'm good with it hypothetically, for things that I'm pretty sure are what they are - colds, sprained ankles, mastitis. Would I go to on with an iffy mole, or for thyroid problems, or a fertility issue? Well ... no, because as much as I adore the various nurses I've seen, I'd like somebody who's had the benefit of the most recent research to be the one checking that out. I generally have to be my own best advocate with those,* all things being equal ...

* This message is brought to you by the doc in Pasadena** who tried prescribing me steroid-based medications 3 times within the same session where I'd told him steroid-based meds were the ONE thing I couldn't take. Ah, bless.

** On the other hand, he totally mailed me a coupon for 30% off on my first face or boob lift for my 30th b-day!***

*** OH LA.

 

[Munchkin]

Full disclosure: I am one!

The education level does not differ by state, but level of autonomy in practice does.

From my personal and professional experience, we have more time. As such, I've actually been able to listen to parents and have diagnosed multiple chronic/subtle/obscure conditions because I wasn't just getting in and out treating a child's single symptom. It's ridiculous that someone thinks they should pay less for the same amount (or more!) time spent in the room with you. I am not a student, I am an educated, licensed clinician. We have the same access to current research, guidelines and continuing education as MDs. We also need to complete CME/CEU to stay licensed. We are sent publications from AAP, ACOG et al. I'm not sure why someone would assume we don't stay up to date with all that? I've also been a sub investigator in greater than 50 clinical trials. Few MDs can claim that.

MDs in my practice are booked for 3 physicals and at least one sick EVERY HOUR. I get 2 physicals and one sick. That is not uncommon in today's high overhead society.

I think people assume we are less intelligent. In my practice of 7 providers, I am the only Mensan and only Ivy League grad. I CHOSE to become an NP. A good NP or MD isn't afraid to admit if they need to ask someone more knowledgeable.

My child sees many specialists. In each specialty I've had MDs and NPs who were great and some who were useless.

As for feeling like you got a bait and switch for an appointment, specify when you book that you want an MD. Most practices simply fill slots at requested appointment times. Even if you have a person you think is "your doctor" most groups book based on availability unless requested otherwise. I can't tell you how many times I've walked into a room and been greeted with a person infuriated they had to see "a nurse."' You know what? If you aren't going to trust my knowledge or advice, I don't want to see you either. But, if you didn't make that clear to the scheduler, then the onus is on you since I'm the only person seeing patients today. (BTW, that is NOT directed to anyone on this thread! I just climbed on a soapbox to vent about a particularly onerous interaction I had Friday! Sorry if anyone thought I was replying to them!)

So, over all, it depends on the clinician and the patient, regardless of title. I have both MDs and NPs I will never see again. I have corrected dozens of prescribing errors made by MDs and DOs. But you know what, I've made mistakes, too! One thing I've learned and I implore you all as patients to practice: I ask parents to hold questions/conversation while I'm writing a script. I need to calculate weight based dosing, then calculate which concentration makes the most sense, then calculate quantity needed. That's a lot of important math to do while having a conversation. Mistakes happen when people are distracted. Minimizing distraction minimizes risk for errors across the board.

Don't let the title turn you off. Judge each individual clinician's knowledge base and personality and decide if they are a fit for you.

ETA: I just read my post. I was clearly typing stream-of-consciousness as it is rife with run on sentences and comma splices! Sorry!

 

[vintageinjune]

To be honest, I'd prefer to see an NP for day to day stuff, routine check ups, etc. They are very well trained and I feel they tend to spend more time listening to you and trying to see you as a whole rather than a few different parts. Not that I've had any particularly bad experiences with doctors, but unless I need to see a specialist, NP all the way!

 

[CJ2008]

Don't let the title turn you off. Judge each individual clinician's knowledge base and personality and decide if they are a fit for you.

Thanks for all that information, Munchkin, and for the simple (but effective) solution to not being surprised by requesting I want an MD for those times when I do.

I do want you to know that when I made the appointments at this particular practice though, they WERE made with Dr. X - but when I showed up found instead of Dr. X I was seeing NP x.

I think the bottom line is in that sentence I quoted from you - it really does boil down to each individual.

Aside from getting a "feeling" as to an NPs knowledge level...what can I ask about them before I make the appointment, or even directly, to judge whether they might have a good knowledge base?

 

[Munchkin]

That's not cool. If you book to see provider x they shouldn't call and say, "sorry, you're seeing provider y." The one thing that happens a lot in my group, though, is summer rescheduling/scrambling when Dr. A suddenly decides they must take a week off at the end of June. Our secretaries are left offering patients a) the same appointment with a different provider or b) pushing out an appointment until Dr. A will be there.

As for assessing knowledge base, it's just like sizing up a Doctor. Ask friends whose health it similar to yours and whose opinion you trust. (IE, never ask Aunt Bertha who goes through providers like water because they "never listen" and "prescribe all the wrong things." Chances are, no one will ever make her happy!) Ask where they went to school, when they graduated, etc. Sadly, our clinical is not where I think it should be, so you are probably best off seeing an NP who has been out of school a few years.

 

[Nyc2chigal]

OH.
MY.
GOSH.

Funny I am seeing this, as I am somehow stuck with seeing one often at the office I go to for my prenatal doc appts.

I DO NOT this one. At all. She is extremely rude, dismissive, and has a bad attitiude.
She doesn't listen, interrupts when I try to explain something to her, and mumbles when she talks as she leaves the room, so I have no friggin clue what to do (sit there, or get dressed).

I prefer the docs there way more, but it makes me wonder why on EARTH they have her there. She's terrible.
I seriously hope not all NPs are the same.

 

[movie zombie]

when I make an appointment I would expect to be told if it was with a dr or with a NP.
I would not like being called a week before and told my dr appointment was now rescheduled with an NP
I would not like to show up for a dr appointment and be seen by an NP.
HOWEVER, for many thing I have no problem with seeing an NP! but I want to make that choice AT THE TIME I MAKE THE APPOINTMENT.
not being told until a week before or when the NP walked in the door? I would question the medical office and its practices and wouldn't be giving them my business.

 

[TooPatient]

Some of my favorite people to see were NPs or PAs. As were some of my least favorite. Just like doctors, the quality depends on the individual. I like a person who takes the time to know me and listen to what is going on then have the knowledge or resources to find the solution. The NP I saw for several years was super friendly and knowledgeable and was really a pleasure to see. The Dr was rushed, inattentive, scatterbrained, and tended to make lots of mistakes. When she left, I started looking for a new person to see.

 

[zoebartlett]

It doesn't bother me at all to see the NP instead of my doctor. Most times, it's actually more convenient because the NP's schedule seems to align with mine. If I waited to see my doctor every time, I'd probably be waiting quite a while for appointments.

 

[perry]

For routine things NPs are great.

But, they just cannot handle specialized medical situations. I used to have one Doctor. Said Dr. had a significant medical issue and had to instantly retire from medicine - and I ended up with a NP. Said NP quickly referred me to no less than 3 specialist because my situation requires drugs that are not the most common - or dosage patterns not "in the book." So now I see specialist - at a lot more $$$$ and a lot more appointments every year. While I was able to get rid of one of those specialist - I am still now left with transitioning from 2 routine Dr. appointments a year to 6 routine appointments a year.

A single competent Dr. could handle that.... grrrrr....

Have a great day,

Perry