Rebuttal: Do nurse practitioners pose a threat to family physicians?

What makes physicians unique is not their ability to diagnose. Physiotherapists and chiropractors diagnose, as do nurses in remote settings. What distinguishes family physicians is the breadth and depth of knowledge and skills that allows them to diagnose uncommon problems or common problems with uncommon presentations, and to oversee the management of patients with multiple complex problems. That is what those extra years of training provide. Nurse practitioners will become a threat only if too many family physicians practise in a way that is indistinguishable from that of nurse practitioners.

I am not suggesting that all family physicians need to go back to the old model of full-service family practice. Family medicine does need to reaffirm its unique role in the health care system, however, to ensure that it does not lose precisely what makes it unique. For example, family medicine residents do need to spend time on acute care wards in tertiary care hospitals even if they might never practise in such settings: they need the exposure to develop the understanding and experience that will differentiate them from nurse practitioners, and they need to be visible in the system. Family physicians have focused on their unique relationship with patients; they need to add an equally strong focus on preserving the breadth and depth of their training and lifelong learning.

Finally, physicians are disadvantaged politically in relation to nurses because there are comparatively few of them in administration. Even though administration is much less remunerative than clinical practice, a sufficient number of family physicians need to be involved in medical, educational, and government administration to ensure that family medicine continues to have a strong voice in its future.

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