20 Things Doctors Can Do That Nurse Practitioners Cannot Do

Written By: Donna Reese MSN, RN, CSN

NP scope of practice can vary widely from state to state. Strict boundaries define our profession, even for those allowed to practice independently. For the most part, our state scope of practice clearly states what we can and cannot do. Fortunately, many of the previous NP restrictions have been lifted over time, giving us more freedom to practice to our fullest extent.

Although we are not doctors, we have valuable skills and traits as providers. So, what are the differences between a nurse practitioner and a doctor? Besides the obvious difference in our training, you may wonder what can a doctor do that a nurse practitioner cannot do? There are many similarities between what NPs and doctors can offer patients. However, NPs need to know their practice boundaries. Along with knowing your state's scope of practice regulations, “20 things doctors can do that nurse practitioners cannot do” can help to clarify your role as an NP.

WHAT DOES A NURSE PRACTITIONER DO?

Nurse practitioners do many of the same duties as a doctor. NPs can assess, diagnose and treat patients. They can prescribe medication, order tests, and make referrals. NPs are healers and holistic-focused, while doctors are more like scientists who study disease and then try to fix the problem. This difference makes NPs outstanding patient educators and advocates with the patient as the central focus.

NPs enjoy educating patients about the benefits of proper nutrition, exercise, and emotional wellness. At the philosophical level, our focus on disease prevention and overall wellness is one of the differences between an NP and a physician.

Nurse practitioner specialties are broader compared to that of a physician. Due to this expansive focus, NPs are perfect for the role of primary care practitioner.

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WHAT DOES A DOCTOR DO?

Doctors do the same duties as those listed above for a nurse practitioner. In addition, since doctors must complete a residency in a very narrow field of their choice, they have highly specialized skills in the area of expertise that NPs do not possess. For this reason, many patients may be screened initially by an NP and then referred to a specialist doctor for a more focused treatment plan.

In general, physicians tend to treat more complex illnesses. Some also perform surgery.

WHAT CAN A DOCTOR DO THAT A NURSE PRACTITIONER CANNOT DO?

(The following are the 20 things that Doctors Can Do That Nurse Practitioners Cannot Do.)

1. Perform Surgery

One of the leading roles doctors can do that nurse practitioners cannot do is perform major surgery. NPs are not surgeons. They can do minor procedures such as lance boils and suture lacerations, but nurse practitioners are not allowed to perform major surgery alone. NPs can assist the physician in surgery, but their surgical role is typically relegated to supporting and educating the patient pre- and post-op.

2. Deliver Babies

One would think that a nurse practitioner specializing in Women’s Health in the OB-GYN sector could deliver babies. However, delivering a baby is one of the things that a doctor can do that a nurse practitioner cannot do. Women’s Health NPs work with patients before and after delivery but do not deliver babies independently. There is not a nurse practitioner specialty that teaches how to deliver babies.

If you are interested in birthing children, you should take a different advanced nursing practice approach; that of a certified midwife.

3. Fully Practice in SNF Facilities

Currently, Medicare limits NP practice in skilled nursing facilities (SNFs). Medicare does not authorize nurse practitioners to conduct admission exams or monthly assessments at SNFs. With primary care providers hard to come by, NP certification at skilled nursing facilities could serve this often-overlooked population well.

4. Prescribe Medication

In about half of the US states, there is one significant role that a doctor can do that nurse practitioners cannot do; that is to prescribe medication independently. In these limited or restrictive practice states, nurse practitioners must have a doctor's approval before prescribing medication. Once doctors are legally permitted to practice, they are given free rein to prescribe any medication they see fit. Many states limit or require that NPs take additional courses to prescribe specific drugs and are governed by a long list of restrictions and actions to prescribe based on their scope of practice.

5. Be Primary Care Providers

Although the educational track of most FNP schools prepares nurse practitioners as primary care providers, the scope and practice of some states curtail this privilege. While the majority of the states recognize NPs as primary care providers, there is a handful that does not recognize NPs in this role. For instance, Michigan, known for some of the most restrictive practices for NPs, does not explicitly recognize NPs as primary care providers under state law.

6. Can Be an Ophthalmologist

While in school, doctors may choose to become an ophthalmologist as their career choice. NPs cannot be ophthalmologists or specialize in the care of the eyes as there is no NP program for this field.

To become an ophthalmologist, you must first:

• Get your medical degree
• Attend an internship before medical residency
• Complete a 3-year ophthalmology residency
• Obtain your medical license
• Pass exams

As you can see, the schooling of an NP is vastly different than that of an ophthalmologist.

7. Can be an Anesthesiologist

Although nurses can pursue an advanced degree as nurse anesthetists, they are not nurse practitioners. They are nurse anesthetists (CRNA) with their own set of rules to practice. Nurse practitioners do not have programs designed to train nurses to work with anesthetized patients.

If you are interested in a career similar to an anesthesiologist, then you need to pursue a different career path and train as a CRNA.

8. Can Become a Specialist

One of the big things that a doctor can do that an NP cannot do is become a specialist in a field of medicine. Most doctors specialize in a specific field to become an expert in that area of medicine.

Some areas that a doctor may officially specialize in that an NP cannot are the following areas:

• Endocrinology
• Gastroenterology
• Infectious Disease
• Pulmonology
• Neurology
• Radiology

9. Prescribe Schedule II Medication

One thing that doctors can do that nurse practitioners cannot do in some US states is prescribe schedule II drugs. Unfortunately, a few states still place restrictions or limitations on NPs regarding independently prescribing schedule II drugs. Nurse practitioners may be required to be in a collaboration agreement with a physician or have additional educational requirements with applications necessary for permission to prescribe schedule II medication. The scope of practice for this privilege varies widely from state to state.

10. Set Up Practice Independently

Practicing independently is an assumption for all MDs and Dos. However, autonomous practice is one thing a doctor can do that nurse practitioners cannot do in many states. Autonomous practice is when an NP goes solo in medical practice and does not need a collaborating physician for oversight.

Being able to go into business to independently set up practice to the fullest extent of their advanced education is not possible for NPs in states that restrict privileges.

11. Be a Medical Staff Member

One would assume that nurse practitioners would be permitted and even welcomed as medical staff members. However, this is one surprising thing doctors can do that a nurse practitioner cannot do. NPs are not permitted to be medical staff members in many states. Only a handful of states allow NPs to join the medical staff as full members. Other states permit NPs reduced membership of the medical staff or none at all.

12. Prescribe Physical Therapy

As unreasonable as it seems, some states still do not allow or have laws permitting nurse practitioners to order physical therapy. While the NP scope of practice laws in a majority of states allow our profession to order physical therapy, this is one of the more archaic restrictions that delineate what doctors can do that nurse practitioners cannot do in more restrictive states. Luckily, this restriction seems to be on the way out as more and more states allow NPs to prescribe PT.

13. Sign Death Certificates

One more arguable thing that a doctor can do that an NP cannot do in some states is to sign death certificates. The scope of practice of nurse practitioner law for signing death certificates varies. Some states dictate that only a physician can sign death certificates. In contrast, some NPs are granted permission in certain circumstances (such as hospice cases or after a doctor gives approval).

14. Sign Disabled Person Placards

Doctors can sign disability cards without giving a thought to it being questioned. On the other hand, nurse practitioners are not allowed in some states to perform this task. Their state scope of practice will dictate if they can, with some states restricting how nurse practitioners accomplish this action, mainly with physician oversight.

15. Call Themselves Doctor

Using the title doctor is one of the big things that doctors can do that nurse practitioners cannot do that has recently come to light in the news. A California nurse was fined for calling herself doctor although she had her doctoral degree as an NP.

Although NPs can get their DNP and technically hold a doctoral degree, some states explicitly state that NPs cannot call themselves doctors. In the medical field, the confusion between a nurse practitioner with her DNP calling herself a doctor and an MD calling himself a doctor is reasonable. The sticking point is that other medical and education professionals can use the title Dr. before their name.

16. Make Top Dollar

One thing that a doctor can do that an NP cannot do is to command the top salary.

According to the U.S. Bureau of Labor Statistics, doctors have the opportunity to earn more than $208,000 annually. While Nurse practitioners can still make a considerable income, the median NP salary is $123,780, according to the BLS. A physician's additional education and training pays off when it comes to the paycheck in the long run.

17. Sign End of Life Treatment Forms/Plans

One thing that doctors can do that NPs cannot do is sign end-of-life planning and treatment forms. The nurse practitioner scope of practice by state differs on whether an NP can sign these forms. Some states allow NPs to complete the documents, but others still require these forms only to be completed by a physician. Some states do not have a law about this yet.

18. Precept Medical Residents and Fellows

One task a doctor can do that a nurse practitioner cannot do is supervise and precept medical residents and fellows. We have all helped train medical students in one aspect or another. However, only an attending physician can officially supervise and precept medical residents and fellows.

19. Refer Medicaid Patients to Specialists

Medicaid restricts nurse practitioners from independently referring patients to specialists. NPs are allowed only with physician approval, even if they were not a part of the process.

Along these same lines, many Medicaid plans do not allow NPs to issue initial certifications for hospice. A physician must assess a patient to complete the necessary paperwork for this referral. However, an NP typically can recertify a patient for hospice care.

20. Receive Full Reimbursement from Third Party Payers

Many Medicaid plans reimburse nurse practitioners at a fraction of what a physician can charge. This disparity in reimbursement can be found with many of the third-party payers. Some will reimburse NPs at 100% for a fee for service charge if a physician signs the documents, even if an NP performed the services. This avenue to achieve full reimbursement is a questionable system, to say the least.

WHAT ARE THE 5 THINGS THAT A NURSE PRACTITIONER CAN DO THAT A DOCTOR CANNOT DO?

1. Pursue Educational Goals While Still Working.

Nurse practitioner educational requirements are not as extensive or all-consuming as becoming a doctor. Although it is challenging, many NP students work full-time while going to NP school.

2. Achieve Full Credentialing Faster.

The educational path to becoming a nurse practitioner is faster than that of a doctor. We can begin our NP career while aspiring physicians are still toiling in school. That does not mean that we are unqualified for our jobs. Add in our BSN schooling and many years of nursing experience, and we become competent providers.

3. Spend Less Time on Educational Requirements.

In general, doctors have more significant educational requirements for practice than NPs. That translates to less time spent in lectures, conferences, and classes compared to a physician.

4. A Variety of Hospital Roles to Choose From.

Nurses with advanced practice degrees are a top choice for higher nursing roles in a hospital, such as a chief nursing officer or clinical educator.

5. Don’t Have to Renew Certification.

Fortunately for us, nurse practitioners are not required to renew their certification once they finish their schooling and pass their tests. On the other hand, MD specialists must renew their certifications regularly.

WHO HAS MORE AUTHORITY, A NURSE PRACTITIONER OR A DOCTOR?

In general, doctors have the greatest authority of all healthcare providers. They have the most training and are considered the most qualified in their specialized field. However, doctor authority over nurse practitioners has changed over the years. Once considered “physician extenders”, nurse practitioners now function on their own authority in many aspects. Depending on the scope of practice in your state, NPs can practice independently.

However, physician specialists are still considered to be the most capable in their field of practice. They may not have authority over NPs in many situations, but NPs still refer patients to doctors that are more experienced in certain circumstances.

Also, your particular work situation may dictate if a doctor has authority over your practice. Medical hierarchy varies depending on the work environment.

MY FINAL THOUGHTS

As you can see from “20 things doctors can do that nurse practitioners cannot do”, there is a great need for a uniform scope of practice within our profession. Since the NP scope of practice for each state is an ever-changing landscape, it is imperative that you keep up with the current guidelines. Why? Because the list of what an NP is allowed to do is growing for the most part, thankfully. By knowing what we can and cannot do, we can safely practice within the boundaries set forth.

I hope that soon when the question is asked, “what can a doctor do that a nurse practitioner cannot do?”, the answer is relatively short for all NPs in the US.

To be clear, we do not want to replace doctors. Our profession is proud of the holistic and patient-centered care we give. We are a valuable medical entity in ourselves. NPs just want to be able to function to their fullest abilities.