What areas of medicine do nurse practitioners (NPs) tend to avoid?

Areas of Medicine Nurse Practitioners Tend to Avoid

Nurse practitioners tend to avoid highly specialized areas of medicine that require advanced technical procedures and technological interventions, particularly those that are traditionally valued in the medical hierarchy such as surgery and laboratory medicine.1

Understanding NP Practice Patterns and Preferences

The American College of Cardiology's competency framework for nurse practitioners reveals important insights about areas where NPs tend to have less representation or comfort. These patterns emerge from both structural factors in healthcare and professional preferences:

Areas Commonly Avoided by NPs:

1. Highly Technical Procedural Specialties:

   • Surgical specialties requiring extensive technical procedures
   • Laboratory medicine and highly specialized diagnostic fields
   • Areas requiring advanced invasive interventions

2. Specific Medical Subspecialties:

   • Complex Cardiovascular Interventions: While NPs work in cardiology, they typically avoid roles involving advanced interventional procedures 1
   • Neurosurgery: Despite some roles existing, this remains an area with limited NP participation 2, 3
   • Specialized Surgical Fields: Areas requiring extensive surgical training and technical expertise

3. Areas Requiring Extensive Technological Medicine:

   • The ACC competency framework highlights that many advanced cardiovascular procedures are designated for "selected CV nurse practitioners based on practice focus" rather than all cardiovascular NPs 1
   • This pattern reflects a broader tendency to avoid highly technical specialties

Root Causes for These Practice Patterns

Cultural and Professional Factors:

• Medical training emphasizes diseases, technical procedures, and technological medicine over behavioral aspects of medicine 1
• There is a perceived hierarchy in medicine where highly technical procedures are considered more prestigious than primary care 1
• NPs often place less emphasis on technological aspects of medicine compared to physicians 1

Structural Barriers:

• Limited training opportunities in certain specialized fields
• Regulatory limitations in some states regarding scope of practice
• Institutional policies that may restrict NP roles in certain specialties

Areas Where NPs Excel

In contrast to areas they tend to avoid, NPs have demonstrated strong performance in:

1. Primary Care:

   • Research shows NPs provide equal or better quality of care compared to physicians in primary care settings 4, 5
   • Patient education and satisfaction scores are often higher with NP providers 5

2. Chronic Disease Management:

   • Management of stable chronic conditions
   • Patient education and lifestyle modification counseling

3. Specialty Care Collaboration:

   • When working in specialty settings, NPs perform as well as physicians in terms of clinical safety and patient outcomes 5
   • Successful integration in cardiothoracic surgery teams when working in collaborative models 6

Implications for Healthcare Delivery

The tendency for NPs to avoid certain technical specialties has important implications:

• Workforce Distribution: Creates potential gaps in certain specialties while potentially oversaturating others
• Team-Based Care Models: Suggests the importance of collaborative practice models in highly technical specialties
• Education and Training: Indicates potential need for specialized training pathways if NPs are to enter these fields

Evolving Roles and Opportunities

Despite traditional avoidance patterns, NP roles continue to evolve:

• Some NPs are now entering previously avoided specialties like neurosurgery and cardiothoracic surgery in collaborative team models 2, 6
• Development of detailed clinical protocols has enabled NPs to take on more specialized roles 2
• Acute Care NPs are increasingly working in specialized critical care units, including neuroscience critical care 3

Understanding these practice patterns can help healthcare systems better utilize NP talents while addressing potential gaps in specialty coverage through targeted training and collaborative practice models.