What’s Your Beef? Most Common Frustrations in the NP-MD Relationship

Relationships between nurse practitioners and physicians can be complex. The MD might serve as a practice partner to the NP with both parties invested financially in a shared business. The physician might serve as a superior to the nurse practitioner in a position of higher administrative authority. Or, in some cases, the nurse practitioner may employ the physician as part of an NP owned practice. These business relationship scenarios may seem pretty straightforward but they are made complex by educational, legal, and traditional distinctions. 

Right or wrong, the structure of our healthcare system is largely hierarchical, educational distinctions the driver behind where medical providers fall in the system. Physicians most often find themselves on higher rungs of the corporate healthcare ladder with greater administrative responsibilities then nurse practitioner and physician assistants. Given that MDs, NPs, and PAs share a similar role in patient care in many settings, these relationships can get a bit sticky. 

Nurse practitioners share a few common frustrations in their relationships with physicians. Here are their most common complaints. 

Lack of Knowledge about the NP Education

The nurse practitioner education largely consists of one to three years of education depending on course load following a nursing degree. Although nurse practitioner new graduates may have a valuable background in nursing to fall back on, the length of the NP education can’t accommodate the number of skills and clinical knowledge required in most settings. So, new NPs must learn on the job to compensate. Physicians having completed a four-year medical program followed by a residency don’t experience the education to practice transition in the same sense. They arrive on the job with years of specialty specific training and hands-on experience. This discrepancy leads to a host of problems in the NP-MD relationship when nurse practitioners are hired without the understanding that additional training may be required to get the NP up to speed. 

Unreasonable Expectations

The natural consequence of many physicians’ lack of knowledge about the nurse practitioner education is unreasonable expectations placed on the nurse practitioner. Inexperienced NPs requiring mentorship and training may not be able to take on a full clinical load in their first months of practice. Nurse practitioners may require assistance treating patients of higher acuity and guidance performing procedures. When the expectation is that on day 1 the NP be able to keep up with a high patient volume, perform advanced procedures, and have highly specialized knowledge, frustration mounts. These skills take time to develop. 

Misconception of the NP Role

Experienced and new grad nurse practitioners lament that many physicians aren’t quite sure how to use advanced practice providers in their practice. Some underestimate nurse practitioner’s abilities, relegating them to history-taking or treating only the lowest acuity patients, even when experience qualifies the NP for a greater level of responsibility. On the other hand, some practices may ask nurse practitioners to take on procedures and clinical responsibilities outside of their scope of practice. This leaves the NP legally exposed. Misconceptions about nurse practitioner’s scope of practice lead to job dissatisfaction and mismanagement. 

Attitude

Healthcare may be hierarchical, but that doesn’t mean physicians should operate with a holier than thou attitude. And, most don’t. Occasionally, however, doctors put down NPs and PAs deeming them a bother or treating them as second class citizens. Attitude also plays a role in management. Very few physicians receive training when it comes to managing a healthcare team. NPs and PAs employed by physicians often express dissatisfaction with the style of leadership and managerial decisions made by physician managers or employers. 

What frustrations have you experienced in your professional relationships with physicians?

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