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Scott Cuyjet, RN, MSN, FNP-C, practices adolescent medicine in the San Francisco Bay area.<\/p>\n
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\nRecently, a registered nurse was demeaned for wearing a stethoscope in a beauty pageant by some who believe it is an instrument solely for use by doctors. Hopefully the consequent backlash resulted in educating the general public that it is a tool used by many in the medical profession. It was nice to see many doctors coming forth on behalf of nurses and explaining how much more frequently nurses use stethoscopes than doctors do. As an advanced practice provider (APP), I have encountered a great deal of camaraderie and respect among my MD peers, but a statement by a physician in a recent news article shows there is still work to be done in promoting better understanding of and respect for APPs.<\/p>\n
In an Oct. 12, 2015 MedlinePlus news article<\/a> summarizing those study results, the authors quote Dr. Paul Heidenreich, a coauthor of an editorial<\/a> accompanying the original research article, who states, “The findings confirm prior studies that show that advanced practice providers such as physician assistants and nurse practitioners can do as well or better than physicians at delivering simple but important care such as education, smoking cessation counseling, ordering cancer screening tests and vaccinations.”<\/p>\n My disappointment in the editorialist\u2019s summation is this: You don\u2019t need to be an NP or PA to do all but one (ordering cancer screening tests) of the tasks that he mentions. An NP or PA may do them as part of a visit but may also delegate them to a nurse or medical assistant. To me, the statement is demeaning to APPs, downplaying our roles in performing clinical tasks comparable to those of physicians: seeing patients, getting histories, doing exams, ordering labs or other tests, prescribing medications, and making referrals in complicated cases (primary care MDs also refer patients when cases extend beyond their expertise). Although the title of the news item is \u201cDoctors, Nurse Practitioners Offer Comparable Outpatient Heart Care,\u201d the key word of comparable <\/em>(synonyms: similar, like), seems absent or overlooked in Dr. Heidenreich\u2019s comment.<\/p>\n![\"stethoscope\"](\"http:\/\/blogs.nejm.org\/frontlines-clinical-medicine\/wp-content\/uploads\/sites\/8\/2015\/11\/stethoscope.jpg\")
<\/a>The October issue of the Journal of the American College of Cardiology<\/em> contained a study<\/a> assessing differences between physicians and advanced practice providers in quality of outpatient cardiovascular disease care. In their discussion, the authors summarize their results as follows: \u201cThe quality of outpatient CVD care measured by compliance with performance measures by APPs was equivalent to that of physician providers on most measures, and was even marginally better for APPs on some CAD measures.\u201d They also note that compliance with CAD performance measures was low in both provider groups.<\/p>\n