You do not care about the patient!
This is my first “OP”Reddit post, and I want to address the hostility toward nurse practitioners—not only in the United States, but internationally.
Let me be clear: not every NP is prepared for independent practice. NP education is inconsistent, some programs need stronger standards, and NP and physician training are not identical. Those are legitimate concerns.
But they do not explain the level of disrespect directed toward the entire profession.
The NP role grew largely out of a need for greater patient access. There were not enough physicians, particularly in primary care and underserved communities. NPs helped fill that gap. Yet now that NPs can evaluate, diagnose, prescribe, and manage much of a patient’s care, some people appear resentful that nurses have gained authority once reserved almost exclusively for physicians.
If patient safety were truly the priority, physician supervision would be meaningful, educational, and competency-based. It would help an NP develop clinical judgment, demonstrate readiness, and eventually practice with greater autonomy.
What does not make sense is indefinite supervision.
If an experienced NP must remain attached to—and sometimes pay—a physician who has little meaningful involvement in the patient’s care, that is not true supervision. It is permanent financial and regulatory dependency.
Real supervision should prepare someone to progress. If it never ends, what exactly did it accomplish?
Clinicians will always need consultation. Physicians call other physicians. NPs consult physicians and other NPs. That is responsible collaboration—not permanent professional subordination.
There is also an uncomfortable issue within the NP profession itself. Some internationally trained physicians who are unable to secure a U.S. residency position or complete the pathway to physician licensure later pursue nursing and become NPs. The barriers they face are real, and many become excellent NPs.
However, some enter the profession as a fallback rather than because they genuinely want or respect the NP role. They may carry the same belief that NPs are inferior, sometimes disparaging the very profession they now practice or viewing themselves as different from “regular” NPs because of their prior medical education.
This should not be generalized to all internationally trained physicians. But we should acknowledge that NP bashing sometimes comes from within—from people who hold the credential but never truly accepted the professional identity.
There is another major contradiction: some practices call NPs inadequately trained while simultaneously using them to manage large patient panels and generate revenue. You cannot claim an NP is too unsafe to practice independently while relying on that same NP to treat your patients—and then collect a supervision fee without providing meaningful supervision.
That is not patient protection. It is exploitation disguised as oversight.
Education matters, but education alone does not create a strong clinician. Physicians know that residency, repeated exposure, mentorship, and years of practice are what transform knowledge into judgment. The same principle applies to NPs.
I am evidence that proper NP development can work. I received meaningful supervision, gained experience, continued learning, and developed the judgment to know both what I can manage and when consultation or referral is necessary.
We should reform weak programs, strengthen clinical training, create meaningful transition-to-practice pathways, and hold poorly performing clinicians accountable—regardless of their title.
But disrespecting an entire profession and maintaining supervision arrangements that primarily generate income will not improve patient care.
If the concern is quality, build a system that develops and measures quality.
If the concern is access, stop obstructing qualified clinicians from providing it.
And if the system continues profiting from NPs while treating them as inferior, then this conversation was never entirely about patient safety.
