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The findings of this study confirm earlier conclusions that, like our physician colleagues, the vast majority of nurse practitioners lack adequate preparation to manage common nonsurgical musculoskeletal problems.

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Achilles tendon rupture example, 3 it isn't clear how the emergency room physician missed the diagnosis, unless s/he simply never evaluated the patient or reviewed his record. Assuming the patient gave an accurate history of his injury in both the ER and the primary care office, appropriate training and protocols should have-at least theoretically-raised red flags indicating the need for specialty consultation.In practice, however, it appears that a majority of primary care physicians may lack the knowledge and skills to accurately diagnose and appropriately treat or refer common orthopedic conditions. 2 Likewise, unless they actively seek specialty training, most nurse practitioners (NPs) report a lack of confidence in their orthopedic skill set. The good news is that both knowledge and skills improve among primary care physicians who obtain additional training in orthopedics. There is no reason to believe that NPs and physician assistants (PAs) wouldn't improve with the same training.As Dr Pinzur points out, NPs and other non-physician providers have been integral to the evolution of joint replacement as a safe and efficient treatment option for millions of people. Perhaps one key to this success has been the transition from a surgeon-driven care model to a more patient-focused team approach. Multidisciplinary care acknowledges that outcomes for even the most technically adept surgeon rely on the contributions of non-physician providers whose complementary skill sets improve results as well as patient satisfaction.As a new health care delivery system takes shape, a first step in assuring that patient safety remains a primary focus might be to change our conceptions of non-physician providers. Rather than being thought of as "trained physician extenders," NPs in particular should be regarded as learned professionals in a distinct discipline. As such they must be held accountable for mastery of both the theory and skills required for practicing safely, effectively, and efficiently regardless of their chosen specialty area or practice setting. 1 In one future scenario, access to treatment may be improved by the availability of basic "specialty" care within primary care settings. For instance, inclusion of a providers with orthopedic training on the staff of emerging "medical homes" could make a wide range of preventive, diagnostic, educational, and management services available for many chronic musculoskeletal conditions. In-house "primary care orthopedics" might also ensure more timely and appropriate referrals for acute and operative conditions, and improve coordination of care throughout the perioperative period.Toward that end, two doctoral students at Samuel Merritt University's School of Nursing in Oakland, California, are currently developing an orthopedic curriculum for nurse practitioners. Three graduate level courses (theory, skills, and residency) will be available as electives. The goal is to better prepare nurse practitioners to work with medically trained colleagues to safely and effectively prevent,...

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