Basic value choices are at issue. Despite what amounts to a ringing declaration of the worth and value of nurse practitioners that validates the focus of advanced nurse practice, advanced practice nurses have been reluctant to defend their value in terms of reimbursement. A fair way to judge what NPs should be reimbursed against what physicians are reimbursed is to look closely at what work both groups of wage earners actually do. Since the medical model of illness care is presently reimbursed at higher wages than the nursing model of wellness and preventive care we need to look closely at the differences between the models, and at what is currently valued by society. Both models begin their work with an assessment of the presenting problem in a context of a review of systems.
Medicine concentrates on reported symptoms from a review of the body's anatomy and physiology.
Nursing focuses on this same report but looks through different lenses, the lenses of the individual's culture, community, family, and work, and what the client's illness means to them. Medicine and nursing both then proceed to an objective examination of the patient looking for signs of illness through a disciplined procedure of physical examination. Both carefully look for indications of physical disease, but again the nurse, with her holistic approach, looks for other connections, between job, family, community, and culture that invest the presenting problem with a meaning that can only be known to the patient, and cannot be found with physical examination only. Next medicine and nursing proceed to the diagnosis. Using only the medical model presents great limitation to this process.