Ask the doctors: Visiting nurse practitioners instead of doctors

Dear Doctors: You often advise people to consult their doctor, but these days that relationship has been replaced by a nurse practitioner. A discussion with an NP about a condition or whether a certain screening test is appropriate is not the same as with a doctor. So what do we do?

Dear Reader: You have identified a gradual but significant shift in primary healthcare in the United States. For a growing number of people seeking medical care, a nurse practitioner, or NP, may be the first point of medical contact.

Some patients feel uneasy about this change. But understanding the education and clinical training the profession requires is often reassuring. A nurse practitioner is a licensed healthcare provider who has successfully completed advanced levels of training. This includes a two- or three-year master’s program and between 500 and 750 hours of supervised clinical practice. Training focuses on the assessment, diagnosis, treatment and management of a range of common diseases, disorders and conditions.

It’s true that unlike physicians, NPs are not required to complete a residency program to get licensed. However, education and training are only part of a bigger healthcare picture. We think it’s also helpful to understand how nurse practitioners fit into the medical team. This is particularly true in areas where doctors are in short supply. In most cases, nurse practitioners are part of, and supported by, a larger system of care. When working with patients, NPs routinely consult with physicians. And if a higher level of care is needed, the appropriate physician or specialist can be called in.

For patients like yourself, who grew up in the family doctor era, this new healthcare paradigm can be frustrating. It can often include longer wait times for an appointment, shorter office visits and less chance to build a long-term relationship with a single physician. Getting the most out of this new system means viewing NPs as a starting point, not the end point, of your medical care.

This often means more active participation. Useful strategies include preparing a list of questions. This should include what the next step will be if symptoms persist, and how you’ll get lab or test results. Bring along a list of all medications you take and their dosages. It’s easy to get overwhelmed by new information, so consider taking notes. Some patients find it helpful to bring a relative or friend to the appointment as backup.

Follow-up is also important. Ask who to call if you have further questions. If you feel your concerns aren’t resolving, request a follow-up appointment. With a clearer understanding of the roles and abilities of NPs, patients can navigate these new systems and get the care they need.

Send your questions to askthedoctors@mednet.ucla.edu.