I've been mulling over comments that nurse practitioners can replace family doctors. Underlying this is a fundamental misunderstanding in the kind of education that nurse have vs doctors. It's not a statement about ability, intellect etc. I work with some amazing nurses

I rely heavily on them to do their job and their skill set is different than mine. That's important. I can't replace a nurse. I've never heard anyone say - in a nursing shortage - oh well we'll just replace them with doctors. It would be a disaster.

Nursing is a very technical profession. They learn a lot about many different procedures that span all disciplines in medicine from setting up IV's (which we all learn) to dressing wounds, changing beds, the right way to collect cultures, to technical aspects of devices like

insulin pumps, glucometers, and the tools patients use in their personal care. In my practice I absolutely need that support. I don't have experience teaching patients how to test glucose, I don't know the ins and out of every glucometer, but I do know the physiology of all

the different insulins, I have studied the differences in genetic forms of diabetes versus mitochondrial disease versus pancreatic insufficiency - these are not things in the nursing curriculum. A lot of the science, physiology, pharmacology, biochemistry of medicine is not

part of nursing school. It's not a failing of their training, it's to allow time for them to learn all of the other skills necessary to assist in the OR or with a delivery, or to manage 5 IV poles with 10 different devices all doing different things, flushing central lines,

I could honestly go on and I would love to hear from a colleague who was a nurse now MD. While I know this is a dream, I would love to see comments on twitter be based in an understanding and if you don't, then ask a question to promote discussion. #thoughtfuldiscourse