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Career Coach

Dear "Supervising/Collaborating" Physician

Published September 3, 2014 1:07 PM by Renee Dahring

Dear "Supervising/Collaborating" Physician,

Our relationship has to change. 

It's not you, it's me. I have changed. I have grown and matured. I am not the same nurse practitioner I was when we first met. I have been around awhile now; I am no longer a new profession that is trying to find my role in the healthcare world. I have been working hard, and over the last few decades I have gained experience and confidence. I feel I have proven myself, and now I have the studies to prove that I consistently provide quality patient care that has equal or better outcomes. You seem surprised - you say that you don't understand why I feel need to move on. I recognize that you are hurt because you thought our relationship was fine and that we seemed to be getting along so well. I suppose this is part of the problem, you haven't really been paying attention. The truth is this relationship has been working better for you than it has for me.

I need some space. I'm not okay with these "agreements" you have been forcing me to sign. Yes, I know you feel somewhat protective when it comes to the practice of medicine, but the bottom line is that you are a physician and I am a nurse practitioner. As time goes on, I have begun to realize that it just doesn't seem right that one profession can determine the fate of another. You and I are different. You need to accept that just because we do some of the same things does not mean you have the right to be in control of my practice. Perhaps you aren't aware of this, but many of your colleagues have been charging us an obscene amount of money for these "supervisory" agreements. Why should we pay a lot of money for a signature on a piece of paper that doesn't result in any benefit to our patients or improve healthcare? In fact, all this paperwork has actually decreased access to care by adding unnecessary restrictions on my practice and adding more cost to an already overburdened healthcare system.

We can still be friends. I value the relationship we have had over the years and hope I can still count on you to be there when I need you. But for our friendship to move forward, you are going to have to trust me. You will have to trust that I was educated to know my limits and that I know when it is time to refer my patients. The only thing that is changing is that we will no longer need such a formal agreement. You see, I have also noticed you don't treat other professionals the same way you treat me. I find it hard to believe that we need to have a written agreement with each other when I see you freely collaborating with your colleagues. Just because I want to end the "supervision" part of our relationship doesn't mean I don't respect your knowledge. We will still work together, but now it will be as peers that both bring valuable contributions to patient care. 


The Nurse Practitioner


Career Coach : Dear "Supervising/Collaborating" Physician

October 18, 2014 2:35 AM


I would like to see the same for PAs. Working side by side with physicians but none of us having someone responsible for us. We are full professionals and adults.

Good work.


Dave Mittman, PA, DFAAPA September 4, 2014 4:03 PM

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About this Blog

    Occupation: Nurse Practitioners and NP Recruiters
    Setting: correctional healthcare/career consulting/teaching
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