We are writing in response to the American College of Physicians' recent position paper on the role of physician assistants and nurse practitioners [1]. As registered nurses studying to become nurse practitioners, we represent a growing force of providers who will be prepared to provide primary care to many persons in all stages of life. It is important to clarify some misleading issues described in the College's position paper.

In the paper, the educational preparation of the nurse practitioner was compared with that of the physician assistant. It is noted that nurse practitioners spend 9 to 24 months learning the expanded role in which they can diagnose and treat commonly occurring acute and chronic illnesses. Physician assistants have 24 months of training in which to learn the same. What was not made clear in the College's statement is that nurses must have at least a Master's degree in nursing to be certified as a nurse practitioner by our professional organization. To be accepted into a Master's program, a nurse must have already completed a Bachelor of Science degree, which in the field of nursing requires an average of 4 years of undergraduate work to complete, and must have practiced as a registered nurse for at least 1 year. Therefore, to be prepared for the role of nurse practitioner, a person must have between 6 and 7 years of educational and clinical preparation. Most of our classmates have many more years of clinical practice than that described here. In addition, State Boards of Nursing control the licensing requirements of nurse practitioners, and most now require that nurse practitioners be certified.

The College supports the role of practitioners only when the physician is responsible for the quality of care provided. Physicians must understand that nurse practitioners practice under their own licenses, not under that of a physician. Nurse practitioners must be accountable not only to physicians but also to the patient, the profession, and themselves.

We do agree with the College's position that the scope of practice should be evidence-based. We welcome the availability of research funding and interdisciplinary research done collaboratively between the nursing and medical professions. In addition, the College supports the development of collaborative communication systems. We do believe that collaboration is essential to safe and effective health care and support the search for more cost-effective and higher-quality ways to provide primary health care to all persons in the United States.