SCOPE OF PRACTICE
Local Thoughts on a National Issue
by BENJAMIN ROGERS , MD
Note : Dr . Rogers works closely with and respects his APRN colleagues . This is meant to review a timely article ; the original article does not represent the opinions of Dr . Rogers or GLMS .
Advanced Practice Nurse Practitioners ( APRNs ) have seen a surge in power and clinical presence since I began residency that is hard to overstate . The scope of their practice has expanded such that to the casual observer , it would be difficult to understand the delineation between APRN and MD . Indeed , many patients have begun adopting the practice of addressing his or her APRN as “ Doctor ” regardless of whether or not they have received their Doctorate of Nursing Practice ( DNP ), which is not required to obtain the APRN certification . Further , on my own personal doorstep ( gastroenterology ), recent investigations have suggested that minor procedures , namely colonoscopies , could be handled by nurse practitioners . 1
It was in this context that a discussion on the future of the field from the medical perspective was planned . The original intent was to provide some hard data , but also to shed some light on the way APRNs see themselves . However , a recent Bloomberg article has garnered so much attention that it is worth taking a quick detour before we start applying some of our own brass tacks .
In the article , subtitled The Miseducation of America ’ s Nurse Practitioners , 2 a fair amount of information was outlined , including some of the statistics that would accompany an accounting
16 LOUISVILLE MEDICINE of the state of affairs . The authors report that nearly 300,000 nurse practitioners are licensed in the U . S . The next sentence outlines the way the ratio of APRNs to doctors has increased from 1 APRN to every 5 physicians or surgeons in 2014 , to 1 in 2.75 last year . Per their accounting , in fact , nurse practitioner is the fastest growing profession in the country . But beyond these numbers , we should consider a few with dollar signs . The median salary for an APRN in 2022 was $ 121,610 according to US News ’ list of 100 Best Jobs 3 ; this is less than half of the Medscape report last year of average physicians ’ salaries . 4 Despite this difference , reimbursements to hospitals are often quoted at 75-100 % of the rate of MD billing for APRNs .
On the emotional side , just a few sentences down in the Bloomberg article comes a sentence that outlines the way a former director of the largest APRN program in the country said she could not recall denying a single student for acceptance into their program . This is in the context , the authors note , of 600 U . S . schools that graduate APRNs , more than triple that of medical schools . This has been made possible by the reality that many APRN training programs are entirely online . Additionally , the fastest training programs award degrees following three years , which encompass a Bachelor ’ s and Master ’ s in Nursing in addition to registered nursing licensing . The time required in the clinical setting is 500 hours ( less than 5 % of what would be required to become a family practitioner who worked 40 hours per week during medical school and residency ).