Understanding the scope of practice for healthcare providers can sometimes be confusing, especially when comparing Nurse Practitioners (NPs) and Doctors (Physicians). While both professions play vital roles in patient care, there are distinct differences in their training, responsibilities, and legal allowances. For Nurse Practitioners, knowing these boundaries is crucial for safe and effective practice. This article clarifies “What Can A Doctor Do That A Nurse Practitioner Cannot do,” outlining 20 key distinctions to help both healthcare professionals and patients understand their respective roles.
Understanding the Role of a Nurse Practitioner
Nurse Practitioners are advanced practice registered nurses who are qualified to diagnose, treat, and manage a wide range of health conditions. They assess patients, order and interpret tests, prescribe medications, and develop treatment plans. NPs are known for their patient-centered approach, often emphasizing holistic care, disease prevention, and patient education. Their broad training makes them particularly well-suited for primary care roles, focusing on the overall wellness of their patients.
Understanding the Role of a Doctor (Physician)
Doctors, also known as Physicians, share many responsibilities with Nurse Practitioners, including diagnosing and treating illnesses. However, their extensive education and specialized residency training equip them with in-depth expertise in specific areas of medicine. Physicians often manage more complex medical cases, perform surgeries, and lead specialized medical teams. Their training is deeply rooted in the scientific study of disease, focusing on diagnosis and targeted treatment strategies.
20 Things Doctors Can Do That Nurse Practitioners Cannot
Despite the growing autonomy and expanded scope of practice for Nurse Practitioners, there remain significant areas where the capabilities of doctors differ. Here are 20 things doctors can do that nurse practitioners generally cannot:
1. Perform Major Surgery
Doctors, specifically surgeons, are qualified to perform major surgical procedures. While Nurse Practitioners can perform minor procedures like wound suturing and abscess drainage, they are not trained or legally authorized to conduct major surgeries independently. NPs may assist in surgical procedures, often focusing on pre- and post-operative patient care and education.
2. Deliver Babies Independently
Obstetricians, who are medical doctors, are trained to deliver babies. Although Women’s Health Nurse Practitioners play a crucial role in prenatal and postnatal care, they do not independently deliver babies. Certified Nurse Midwives (CNMs), a separate advanced nursing practice role, are qualified to deliver babies, but this is distinct from the NP role.
3. Conduct Comprehensive Admission and Monthly Assessments in SNFs Under Medicare
Current Medicare regulations place limitations on Nurse Practitioner practice within Skilled Nursing Facilities (SNFs). NPs are not authorized to perform initial admission exams or mandatory monthly assessments for Medicare patients in SNFs. This restriction limits the role NPs can play in providing primary care within these facilities, even though their expertise could be highly beneficial for this population.
4. Prescribe Medications Independently in All States
In some states with restrictive practice environments, Nurse Practitioners are not permitted to prescribe medications without physician oversight. Doctors, once licensed, have broad prescribing authority. While many states grant NPs full prescriptive authority, some still require collaborative agreements or limit the types of medications NPs can prescribe without physician approval, particularly controlled substances.
5. Be Formally Recognized as Primary Care Providers in Every State
While Family Nurse Practitioner programs specifically prepare NPs for primary care roles, not all states legally recognize them as primary care providers. Some states have scope of practice laws that do not explicitly include NPs in the definition of primary care providers, which can impact their ability to practice to the full extent of their training in those regions.
6. Specialize as an Ophthalmologist
Ophthalmology, the medical and surgical specialty dealing with eye care, is exclusively within the domain of medical doctors. There are no Nurse Practitioner programs that offer specialization in ophthalmology. Becoming an ophthalmologist requires medical school, residency, and specialized fellowship training, a pathway distinct from NP education.
7. Specialize as an Anesthesiologist
Anesthesiology, the practice of administering anesthesia for surgery and other medical procedures, is a medical doctor specialty. While Certified Registered Nurse Anesthetists (CRNAs) are advanced practice nurses who administer anesthesia, they follow a different educational and certification path than Nurse Practitioners. NP programs do not offer training in anesthesiology.
8. Become a Highly Specialized Medical Expert in Certain Fields
Doctors have the option to pursue highly specialized medical fields through residency and fellowship training after medical school. While NPs can specialize to some extent, the depth and breadth of specialization available to physicians are far greater. Specialties largely exclusive to doctors include:
- Endocrinology (hormone disorders)
- Gastroenterology (digestive system)
- Infectious Disease
- Pulmonology (respiratory system)
- Neurology (nervous system)
- Radiology (medical imaging)
9. Prescribe Schedule II Medications Independently in Every State
Prescribing Schedule II controlled substances, which have a high potential for abuse, is restricted for Nurse Practitioners in some states. While many states allow NPs to prescribe these medications, some require physician collaboration, specific educational requirements, or application processes to obtain this privilege. Scope of practice regulations vary significantly across states regarding Schedule II prescriptions for NPs.
10. Set Up a Medical Practice Completely Independently in All States
Physicians generally have the autonomy to establish independent medical practices across all states. However, in states with restricted practice laws, Nurse Practitioners may face limitations in setting up fully independent practices. Autonomous practice for NPs, meaning practicing without mandatory physician oversight, is not permitted in all regions, limiting their entrepreneurial opportunities and practice autonomy.
11. Be Full Medical Staff Members in All Hospitals
Hospital medical staff membership policies can sometimes differentiate between doctors and Nurse Practitioners. In many states, NPs are not granted full medical staff membership rights in hospitals. Some states allow for limited or provisional membership, while others restrict NPs from being medical staff members altogether. This can affect their roles in hospital governance and clinical decision-making processes.
12. Prescribe Physical Therapy Without Restrictions in Every State
Ordering physical therapy (PT) is generally within the scope of practice for Nurse Practitioners in most states. However, some states still have outdated regulations that restrict or complicate the ability of NPs to independently prescribe physical therapy. These restrictions, while diminishing, represent areas where doctors have historically had broader authority in directing patient care.
13. Sign Death Certificates Without Specific Conditions in Every State
The legal authority to sign death certificates varies by state for Nurse Practitioners. In some states, only physicians are authorized to sign death certificates. Other states may allow NPs to sign death certificates under specific circumstances, such as in hospice care or with physician approval. This variability highlights another area where physician authority is sometimes legally prioritized.
14. Sign Disabled Person Placards Without Question in Every State
Doctors routinely sign disabled person placards or forms without issue. In contrast, Nurse Practitioners in some states are not authorized to sign these forms, or their ability to do so is restricted and may require physician oversight. State scope of practice laws dictate whether NPs can independently perform this function for their patients.
15. Use the Title “Doctor” Without Potential Legal Repercussions in a Clinical Setting
While Nurse Practitioners who hold a Doctor of Nursing Practice (DNP) degree technically possess a doctorate, using the title “Doctor” in a clinical setting is a sensitive issue. Recent cases and regulations have highlighted that using “Doctor” by a DNP-prepared NP can be misconstrued as misrepresentation, implying they are a medical doctor (MD or DO). Physicians, holding MD or DO degrees, rightfully use the title “Doctor” without such legal or professional ambiguity.
16. Command the Highest Average Salaries in Healthcare
Physicians, due to their extensive education, specialized training, and broader scope of practice, typically earn higher salaries than Nurse Practitioners. While NP salaries are substantial and growing, data from the U.S. Bureau of Labor Statistics consistently shows that physicians, on average, have the potential to earn significantly more annually.
17. Sign End-of-Life Treatment Forms/Plans Independently in Every State
The authority for Nurse Practitioners to sign end-of-life care documents, such as advance directives or Physician Orders for Life-Sustaining Treatment (POLST) forms, varies by state. Some states permit NPs to sign these documents independently, while others require physician signature. This inconsistency reflects the differing legal recognition of NP authority in critical end-of-life decisions.
18. Precept Medical Residents and Fellows as the Primary Supervisor
Doctors, particularly attending physicians, are uniquely qualified to serve as primary supervisors and preceptors for medical residents and fellows. While Nurse Practitioners may contribute to the education of medical students, the formal and primary preceptorship of medical residents – physicians in postgraduate training – falls under the purview of attending physicians.
19. Independently Refer Medicaid Patients to Specialists Without Physician Approval
Medicaid regulations in many states impose restrictions on Nurse Practitioners’ ability to independently refer patients to specialists. Often, physician approval is required for Medicaid referrals initiated by NPs, even when the NP is managing the patient’s primary care. Similarly, initial hospice certifications under Medicaid often require a physician’s assessment, while NPs may be authorized for recertification.
20. Receive Full Reimbursement Rates from All Third-Party Payers
Reimbursement disparities exist between physicians and Nurse Practitioners from some third-party payers, including Medicaid and private insurance. In some cases, NPs may be reimbursed at a lower rate than physicians for the same services. Furthermore, some payers might only provide full reimbursement if a physician co-signs documentation, even if the NP provided the direct patient care. This system creates financial inequities and undervalues the services provided by NPs.
5 Things Nurse Practitioners Can Often Do That Doctors May Not Prioritize
While the list above highlights what doctors can do that NPs cannot, it’s also important to recognize areas where Nurse Practitioners offer unique strengths and approaches:
1. Pursue Advanced Education While Maintaining Employment
The educational path for Nurse Practitioners is often more flexible than that of physicians. Many NPs pursue their advanced degrees while working full-time as registered nurses. The demanding and lengthy nature of medical school and residency typically makes it impractical for aspiring doctors to work full-time during their training.
2. Achieve Autonomous Practice and Full Credentialing More Quickly
The timeline to independent practice is generally shorter for Nurse Practitioners compared to physicians. NP education and credentialing processes are less extensive, allowing them to enter advanced practice roles and achieve autonomy in states that permit it sooner than physicians complete their lengthy training.
3. Focus on Holistic, Patient-Centered Care and Education
Nurse Practitioner training often emphasizes a holistic, patient-centered approach to care, with a strong focus on patient education, disease prevention, and wellness. While doctors also provide patient education, the NP philosophy often prioritizes these aspects as central to their practice model.
4. Fill Critical Healthcare Gaps, Particularly in Primary Care and Underserved Areas
Nurse Practitioners are crucial in addressing healthcare shortages, particularly in primary care and in rural or underserved communities. Their ability to provide comprehensive primary care services makes them essential in expanding healthcare access and improving population health outcomes, often in areas where physician availability is limited.
5. Adapt to a Wider Variety of Healthcare Roles
The broad-based training of Nurse Practitioners allows them to transition into diverse healthcare roles within hospitals and other settings. From clinical leadership positions to specialized NP roles across various departments, their versatility is a significant asset to healthcare systems.
Authority and Collaboration: Doctor vs. Nurse Practitioner
In the traditional healthcare hierarchy, doctors generally hold the highest level of authority due to their extensive training and specialized expertise. However, the relationship between doctors and Nurse Practitioners is increasingly collaborative. While doctors retain ultimate authority in complex medical situations and specialized fields, NPs exercise considerable autonomy within their scope of practice, particularly in primary care and states with full practice authority. Effective healthcare increasingly relies on a team-based approach, recognizing the distinct yet complementary skills of both physicians and Nurse Practitioners.
Final Thoughts: Evolving Roles and Scope of Practice
The distinctions outlined in “20 things doctors can do that nurse practitioners cannot do” underscore the ongoing need for clarity and consistency in Nurse Practitioner scope of practice regulations across the United States. While the trend is toward expanding NP autonomy and recognizing their vital contributions to healthcare, variations in state laws and practice environments persist. Ultimately, a clear and unified scope of practice ensures patient safety, optimizes healthcare delivery, and allows Nurse Practitioners to practice to the full extent of their education and expertise, working collaboratively with physicians to meet the diverse healthcare needs of the population.
