For most of you, the difference isn't significant enough for you to even notice, particularly if needing primary care services. There isn't a ton that a primary care physician would do differently, with regards to clinical care, or could do differently than a family nurse practitioner. Each practitioner, whether nurse practitioner or physician can specialize, find their niche, and really make a name for themselves in any particular area of healthcare, gathering referrals throughout the community.
Primary care practitioners in general is the clinician who manages your overall health. We consider all the necessary screenings you may be an appropriate candidate, particularly as you age, but primary care practitioners also evaluate mental and emotional health, lifestyle behaviors, and we lean into wellness. We manage acute care issues, but the mainstay of our practice is management of chronic healthcare conditions. Primary care clinicians typically serve individuals from their first day of life through their very last.
Our culture though has this perception, stemming back many decades, that the nurse is subservient to the physician. Women were typically nurses and men were physicians, so as the nursing profession has advanced, which historically was not long after that of the physician, it was assumed the nurse would still fall under the supervision of the physician. Our training hasn't done this though; the patriarchy has. Physicians pay lobbiests great riches to assure state rules and regulations maintain their monopoly in healthcare so they can continue oppressing their greatest competitor. Nurse practitioners are trained to meet the full scope of needs of their primary care clients; in fact, they are recognized as experts in their field.
Advanced Practice Nurses can Provide Comparable Levels of Care & Achieve Similar Outcomes as Physicians, if not Better
When studies evaluate the care provided by nurse practitioners as compared to physicians, the literature is not only supportive of nurse practitioners, it starts to question if physicians should ever be higher on the hierarchy than nurses. Nurse practitioners are far less expensive, not just to employ, but their care demands less of the healthcare infrastructure. This is great for our national healthcare financial burden, but this doesn't appeal to hospital financial advisors seeking to pad the pockets of their administration. Physicians are more likely to order expensive diagnostic tests and recommend surgical procedures as compared to nursing clinicians, so you'll find more advanced practice nurses in the military, at the Veteran's Hospital and in all government funded clinics, but large corporations will continue to support physicians as long as capitalizm runs amuck in the United States. We have some of the worst healthcare outcomes, the worst in fact of all industrialized countries in maternal and child health, but dollar for dollar, we are by far the most expensive with which to attain healtcare. Advanced practice nurses have been found to save nations around the world billions of dollars (NHS England, 2014).
Nurse practitioners have also been found to have superior outcomes when researchers evaluate chronic disease outcomes, wait times and even time spent with clients, as well as client satisfaction (Htay & Whitehead, 2021). The role development of advanced nurse practitioners is usually congruent with the four defining pillars of advanced practice, which are clinical practice, leadership, education, and research, and reflect the level at which advanced nurse practitioners are able to operate. Restrictions are political. Requiring written collaboration or even supervision, does not improve clinical outcomes; it only restricts access to care. Nurse Practitioners are now considered essential in meeting the complex needs of patients and generating overall improvements in the quality of care patients receive, and their overall safety.
A 2009 study with researchers Dierick-van Daele et al found patients perceived the high quality care by both nurse practitioners and physicians, but it was nurse practitioners who offered them more time in their consultations and better follow-up and this mattered to the patients. This same outcome was also found in a 2000 study done by Venning et al. A 2003 study found that Nurse Practitioners improved asthma outcomes in a pediatric clientele compared to pediatricians, and a study published in 2000 by Kinnersley et al., found patients care for by Nurse Practitioners were more satisfied with the care they received compared to physicians. The patients of the NPs felt they received better communication, more informationa bout their illnesses and its cause, and more of them would choose an NP upon their return. Outcomes were improved among the elderly when cared for by NPs as compared to physicians in a 2007 study published by Krichbaum. Blood pressures are lower when cared for by nurse practitioners (Mundinger et al, 2000; van Zullen et., 2011), Rheumatoid Athritis is improved (Ndosi et al., 2014), incontinence is improved (Ryden et al., 2000; Williams et a., 2005), and satisfaction in those cared for by NPs as compared to cardiologists were improved in a 2004 study (Stables et al.).
Nurse Practitioners are Client-Centered
Collaboration throughout the healthcare infrastructure is paramount, but it need not be required because our system depends on referrals. Nurses and physicians are complementary practitioners. Neither can truly work independent of the other, but just as you visit your primary care physician and recognize they will refer to a specialist when your needs are outside their own expertise, this is true as well for nurse practitioners; however, the vast majority of your primary care needs can be met by your family practitioner and according to the literature, your outcomes and overall satisfaction are likely to be greater with the Nurse Practitioner.
Htay, M. & Whitehead, D. (2021). The effectiveness of the role of advanced nurse practitioners compared to physician-led or usual care: A systematic review. International Journal of Nursing Studies Advances, 3. http://creativecommons.org/licenses/by-nc-nd/4.0/
Mundinger, M. O., Kane. R. L., Lenz, E. R., Totten, A. M., Tsai, W. Y., Clearly, P. D., Friedewald, W. T., Siu, A. L., Shelanski, M. L. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial. JAMA, 283(1), 59-68. https://www.ncbi.nlm.nih.gov/pubmed/10632281
Ndosi, M., Lewis, M., Hale, C., Quinn, H., Ryan, S., Emergy, P., Bird, H., Hill, J. (2014). The outcome and cost-effectiveness of nurse-led care in people with rheumatoid arthritis: A multicentre randomised controlled trial. Ann. Rheum. Dis., 73(11), 1975-1986. http://ard.bmj.com/content/73/11/1975
Ryden, M. B., Snyder, M., Gross, C. R., Savik, K., Pearson, V., Krichbaum, K., Mueller, C. (2000). Value-added outcomes: the use of advance practice nurses in long-term care facilities. Gerontologist, 40(6), 654-662. https://www.ncbi.nlm.nih.gov/pubmed/11121082
Stables, R. H., Booth, J., Welstand, J., Wright, A., Ormerod, O. J., Hodgson, W. R. (2004). A randomised controlled trial to compare a nurse practitioner to medical staff in the preparation of patients for iagnostic cardiac catheterisation: the Study of Nursing Intervention in Practice (SNIP). Eur. J. Cardiovasc. Nurs, 3(1), 53-59. https://doi.org/10.1016/j.ejcnurse.2003.11.002
van Zuilen, A. D., Blankestijn, P. J., van Buren, M., ten Dam, M. A., Kaasjager, K. A., Ligtenberg, G., Sijpkens, Y. W., Sluiter, H. E., van de Ven, P. J., Vervoort, G., Vleming, L., Bots, M. L., Wetzels, J. F. (2011). Nurse practitioners improve quality of care in chronic kidney disease: two-year results of a randomised study. Neth. J. practitioners in primary care. BMJ, 320(7241), 1048-1053. https://www.ncbi.nlm.nih.gov/pubmed/10764367
Williams, K. S., Assassa, R. P., Cooper, N. J., Turner, D. A., Shaw, C., Abrams, K. R., Mayne, C., Jagger, C., Matthews, R., Clarke, M., McGrother, C. W. (2005). Clinial and cost-effectiveness of a new nurse-led continence service: a randomized controlled trial. Brit. J. Gen. Pract., 55(518), 696-704. https://bjgp.org/content/55/518/696.abstract