[hvert]

I just got health insurance for the first time in a long time. I am trying to find a primary care provider, but it's kind of confusing. It seems that most MDs aren't accepting new patients, but nurse practitioners are.

I'm not really sure what a nurse practitioner is vs. a doctor. Should I have a physical with a FNP or would I be better off looking at a different office for an MD?

[pnw1]

I would prefer a doctor, but that's just me. Maybe I am old

[hvert]

Thanks, I think I would too. I am just not sure if it is rational. FNPs only have two years of grad school. Is the extra schooling a doctor has worth it for stuff like physicals? I don't know. I feel like if it costs me the same, I would rather have an expert.

I was kind of hoping that someone would pop up with a benefit to having a FNP as opposed to an MD.

[gayleggg]

I would also insist on a doctor. My husband sees a NP and I don't feel that she is making the right decisions for him. I prefer someone who has graduated from med school.

I think it kind of depends on how many health problem you have (or may have in the future, based on family history.)

Are you allowed to see an internist for a PCP? That's always my preference, but it's not always possible.

Another option would be to see a PA (physician's assistant). I've had better luck with them than with nurse practitioners. My problem with nurse practitioners is that I've seen ones that were pretty good and ones that were terrible.

If you don't have any health problems and just need someone to see when you have a respiratory infection or something, I think a nurse practitioner is fine.

I'm guessing that you have mental health problems since you post on this forum, though.

You might check where the nurse practitioners are working. If they are working in a practice with a doctor that you like, maybe you could go to them then switch to the doctor when he/she has an opening for a new patient.

My PCP has a NP and a PA working in his office.

I think the sudden appearance of so many NPs is because there's a shortage of primary care doctors in parts of the US.

[hvert]

I haven't been to a primary care doctor in 15-20 years. I'm pretty healthy, but I do have a couple of things I'd like to discuss.

There's a health center that's just a step below a hospital within walking distance of my home, so I was hoping I could go there - but it figures that out of the 20 MDs they have for primary care, only 3 are female and none of them are accepting new patients. I have heard really negative things about one nurse practitioner there.

My area has a severe shortage of PCP. I may be out of luck given that a ton of new people just signed up for insurance to meet the Obamacare deadline and we didn't have enough doctors anyway.

[kim_johnson]

The significant majority of people who go to their GP... Don't actually need to see a GP. something like... 80% or 90% of GP visits... Could have been dealt with perfectly well by a nurse practitioner. And nurse practitioners... Are an awful lot cheaper (for governments or health insurance companies even if not individuals who see them)... So... There is pressure... Or... Incentive... For people to see a nurse practitioner instead.

Apparently nurse practitioners are less intimidating and more 'for the people', or something. Apparently... Public acceptance is higher.

I don't believe it. But there is a shortage of GP's in most areas, for sure.

Can you ask a place whose books are closed... If they can suggest a place whose books are open? Also ask if you can go on a wait-list, if possible, so you are set for the future.

[~Christina]

I prefer a MD , I think both my mental and physical illness goes beyond something a NP could manage.

I would say .. If your a simple case, No on going health problems like BP or heart anything etc .. Basically if you will mainly need someone to help you manage a URI, UTI or something relatively simple ... I think its possible to have a NP and it be a good fit.

If you can't find a MD easily, I would go ahead and hook up with a NP.. If you see the NP and he/she doesnt click then ask them to refer you to a MD , usually they can get you in with a MD a whole lot quicker than you can.

Follow your gut feeling

[Yoda]

It depends on what your health needs are and what training the NP has had.

My son saw a NP for a year or so because she was free to people without insurance and it was truly a case of you get what you pay for. Her specialized training for her master's degree was in diabetic care yet she was exclusively working with psych patients. Neither son nor I were fond of her and she said some really dumb things at times.

I am sure there are competent NP but she wasn't one of them.

[Rose76]

I've worked in healthcare settings, and I've seen nurse practitioners screw up too many times. I highly recommend having an MD as your primary care provider. A board certified internal medicine specialist is the best bet for an adult.

Ordinary nurses can get to be real smart about a specialty area that they've worked in for a long time. But nurse practitioners working as PCPs are supposed to know a lot about a lot of things. They just don't have enough preparation for that to be true.

NPs tend to be people who liked school and enjoyed taking a lot of courses. They got where they got because they were good at studying for tests. But they often don't have all that great of a background in actually working as nurses.

[hvert]

Thanks, all of you - this has been so helpful. I did notice that one doctor with this practice was accepting new patients at a different office that's not too far away, so maybe I will try her.

Since it's been so long since I've seen someone, I really want a person who can identify problems I might not be aware of. I just googled and learned that an NP might only have 2-4 years of schooling, depending on when they qualified for their license. How on earth can their time be billed at the same rate as someone who went to med school?? The medical industry really gets on my nerves.

[wife22]

Well,they don't bill same rates,but every NP should report to MD every case and MD has to sign off on the NP's assessment .
All the best to you!

[IowaFarmGal]

The one I went to misdiagnosed me which caused a delay in getting rid of my troublesome gallbladder.

[tradika]

I have more luck with nurse practitioners than doctors. There are good NPs like there are good MDs. Don't write them off because you got one bad one. At this point I'd rather see a psych np than doctor. Ha

[kim_johnson]

It can totally depend on the person. I currently see a mental health nurse once per week and she's heaps more helpful to me than the majority of psychiatrists have ever been. But she is pretty special

An experienced nurse can be an absolute wonder. Nursing is becoming more and more professional these days, too, and some nurses are more up to date on things than doctors are. Especially if doctors are young or doing something outside what they usually do.

But unless people are all like 'see this person, they're absolutely terrific!' I would typically prefer to see a doc, yeah. But apparently there are a lot of people out there who feel otherwise, so personal preference, yeah.

[JoeS21]

Originally Posted by hvert

I just got health insurance for the first time in a long time. I am trying to find a primary care provider, but it's kind of confusing. It seems that most MDs aren't accepting new patients, but nurse practitioners are.

I'm not really sure what a nurse practitioner is vs. a doctor. Should I have a physical with a FNP or would I be better off looking at a different office for an MD?

I didn't read all of the replies. The one thing I would ask about before picking a nurse practitioner is, "What if I need a doctor to sign off on something?" Is there a doctor that can sign forms on behalf of the nurse practitioner? For example, I'm not sure if a tax form schedule R that says you're disabled can be signed by an NP, or only an MD.

[dillpickle1983]

I see a PA-C most of the time. My doctor is so booked that I never get to see her, and when I am scheduled to see her something pops up and I have to cancel. I'd rather see my doctor on a regular basis than the PA, but the PA is really nice and seems to know her stuff.

[Roi5]

I actually am an NP, so I admit bias.

I think it's best to find the provider with whom you feel most at ease. If you're the kind of person who would never feel comfortable seeing anyone other than a physician, you should see a physician.

But NPs and physicians vary tremendously in their backgrounds, areas of expertise, and bedside manner. There are plenty of awful NPs out there, just as there are terrible physicians. There are good schools and there are mediocre schools. I have four degrees, 12 years of school, and 11 years of practice under my belt. There are some NPs who have far less educational and clinical experience--but that's becoming far less common.

As far as supervision goes, this varies by state law in the US. In about 20 states, an NP can practice on his or her own; no physician is required. In other states, NPs have varying levels of collaboration or supervision requirements. But this assumes that the collaborating or supervising physician is both competent and available. Just because a physician signed the chart doesn't mean that the physician made the right call.

Scope of practice questions are self-regulated. So there are NPs who are far more experienced than their physician colleagues in mental health issues; others not so much. I think it's a terrible idea for someone with a background in diabetes to be managing psychiatric concerns! That's a law suit waiting to happen!

Some NPs limit themselves (or are limited) to the simplest of cases: sore throats, etc. Others manage multiple, complex illnesses, perform minor surgical procedures, or specialise in particular areas like HIV, heart failure, or traumatic brain injuries.

Just be sure to ask questions... the same way you would for a physician. Where did this person go to school? How many years has he or she been in practice? What are his or her areas of expertise?

I think it's also helpful to look on practice web sites. Look to see if you have any common ground with one of the providers available to see you.

I have a GP who is totally miserable. He spends about four minutes (or less); no vital signs, no history, no exam... he just sits behind a desk. I think I could have a stroke while sitting in front of him, and he'd never notice. (Yes, I'm looking for someone else.)

Incidentally, you'll find more NPs called "Doctor" due to the massive rise in doctoral programs for nurse practitioners. Some of these programs are pitifully weak; others are profoundly rigorous. So if you are going to see a doctorally-prepared NP, find out where he or she went to school. Was this some sort of lukewarm, do-it-yourself diploma downloaded as a pdf? Or was it an accredited clinical doctorate from a major academic medical centre?

Above all, find someone you trust. Find the clinician who listens, who returns your calls, who sits down when talking to you, and who is thorough and thoughtful in his or her history and physical exam. Everyone deserves that.

[dillpickle1983]

Thanks for your wonderful insight.

[hvert]

Wow, thanks for all that info, Roi5. I still haven't figured out what I am going to do. I just found out that the place up the street from me has 'care teams' made up of several doctors, PA, NP, DO, etc. It's not clear to me that I even have a choice about who I see if I sign up for a 'care team.'

It's really overwhelming. There are *no* doctors accepting patients outside of the two major hospitals and this one care center near my house.

It looks like my state is one of the ones that is loose with who can be an NP. You don't even need a BA!

[Rose76]

A NP should have a master's degree.

To not have even a bachelor's degree is unconscionable. That is not a primary care provider. Twenty years from now that won't even be considered a professional nurse, but, rather, a clinical technician.

[tradika]

They aren't nurse practitioners unless they have a MSN (master's) degree. As someone said earlier, they are trying to bump this up to a doctoral degree. In the future, you will definitely not see less quality of care in an NP. You might still get a knucklehead like you do in a physician though! Just shop around and find the right fit. I have had some really awesome ones even with a MSN. They knew when to ship me off to a specialist when I needed it.

[hvert]

An RN in my state has to have basic nursing education, which does not even have to be a two year program. An NP needs to qualify for an RN license plus have additional education which may be a certificate, BA, MA, PhD or post doctorate. They also need to pass a certification test, but there doesn't appear to be a list of valid certifying agencies. They also need to be supervised for two years by either a doctor or another NP.

I don't doubt that many NPs are better to deal with than doctors and probably just nicer people in general. I find it annoying that health care still costs an ungodly sum of money while patients are being pushed towards lower paid workers. It's the Walmartification of health care.

My BF made an appointment with his doctor and never made it past the PA who told him to just go home and see what happened after a deer tick bite. It was a two minute appointment. He got a bill for $200. They could have told him over the phone that they weren't going to give him a prophylactic antibiotic or let him see a doctor.

So, when I got my insurance and saw that I can't even have a doctor as my required primary care provider, it made me mad.

[tradika]

An RN is just a registered nurse. They only have to have an associates currently. That will change eventually. They cannot prescribe medication without a masters degree. To my knowledge, no state allows you to become an NP without a masters in nursing science. If they do, please tell me which one.

[Rose76]

Like tradika, I find it hard to believe that any state certifies any nurses as NPs without an advanced academic degree. RNs everywhere need at least a two year college program that awards an associate degree or a three year hospital program that awards a diploma.

Apparently, Maine is the most backward of the New England states with regard to credentialing NPs, but not to the point of requiring as little preparation as stated above.