The relationship between NPs and physicians is sometimes depicted as categorically tense. In reality, these relationships run the gamut, from supportive to hostile and everything in between. Nearly half of states still require a physician to oversee a nurse practitioner’s work, and many more have them working as colleagues in close proximity.
At their best, a healthy physician-NP relationship can be mutually beneficial in a number of ways. Unfortunately, not every relationship can be perfect, and some NPs experience pushback or hostility from their physician colleagues. Even when the circumstances are less than optimal, learning to coexist with difficult colleagues is sometimes necessary to get through the day.
Whether a physician is helping you thrive or testing your patience, there’s value in recognizing the context, challenges and opportunities in navigating MD-NP relationships.
Historical and Structural Roots
To understand why nurse practitioner–physician relationships can sometimes feel complicated, it helps to zoom out. Historically, the U.S. healthcare system has been built around a physician-led model. Doctors have historically been seen as the default authority in clinical settings, and most care teams were structured to reflect that. When the nurse practitioner role was born in the 1960s out of a need to improve access to primary care, it was seen as a helpful extension of care, but not always as an equal.
Since then, the NP profession has grown significantly in both scope and numbers, but the systems around it haven’t always evolved at the same pace. Across regions, institutions, and specialties, the expectations for how NPs and physicians work together can vary greatly. One NP may be viewed as a peer and collaborator, while another may be expected to defer to or seek oversight from a physician, depending on the environment.
Massive workloads, overlapping responsibilities, differences in training, and mixed messages from institutions all can leave both NPs and physicians confused, frustrated, and unsure of how to navigate the working relationship. Let this serve as a reminder that many of these tensions come from systems, not individuals. Understanding this background doesn’t erase the challenges, but it can offer useful context.
When the Going Is Good
When it works well, an NP–physician partnership feels like a true team effort. You complement each other’s skills, communicate clearly, and make shared decisions rooted in mutual trust and patient well-being. These relationships can reinforce your professional confidence, support your autonomy, and help you grow.
Many NPs credit physician colleagues with mentoring them throughout their careers, advocating for their autonomy, or modeling collaborative leadership. In these settings, you’re learning from one another, leaning on each other, and building better systems together. Interprofessional respect is a two-way street, and when it flows in both directions, everyone wins.
When The Going Gets Tough
When NP–physician relationships feel strained, it’s easy to take things personally, even when the behavior stems from broader factors rather than individual intent. Physicians, like NPs, are shaped by their training, clinical environments, and past experiences. Most doctors undergo long, rigorous education programs that position them as the primary decision-makers in patient care. This can make it difficult to adjust to team-based models where authority is more evenly shared.
If you’ve spent any amount of time on the internet, you’ve likely read about, or experienced firsthand, horror stories of doctors who are hypercritical of NPs, writing them all off as categorically incompetent. Some physicians may be wary of the clinical rigor of NP education or attribute one bad experience with an NP in the past to be prescriptive of how all NPs operate. These experiences can be especially draining when they happen over time. You might find yourself hesitating before offering input, avoiding interactions, or replaying conversations in your head after a shift. And while not every moment is tense, the underlying strain can make the workday feel heavier.
You may not be able to change every physician’s perception, but you can let your work speak for itself. Even when interpersonal dynamics are difficult, showing professionalism and excellence reinforces that what you do matters, regardless of who thinks otherwise.
What Works and What Doesn’t
One of the most useful things you can do in a complex working relationship is take a step back and reflect. Ask yourself: What’s working here? What’s getting in the way? Do I feel respected, trusted, and included? When do I feel most confident and supported, and when do I feel the opposite?
Checking in with yourself helps you stay grounded and helps you coexist with difficult colleagues. It can clarify what you need, what you’re willing to tolerate, and which parts of the situation are within your control. If you’ve felt alone in navigating a tense dynamic, you’re far from it. Many NPs, especially early in their careers or during transitions, encounter difficult professional relationships. That awareness can help you get through the tougher interactions.
Investing in Healthy Relationships
Strong working relationships don’t happen overnight. They take time, conversation, and mutual effort. If you’re in a newer or evolving role with a physician colleague, learning to collaborate might mean starting with small but direct steps: asking for input, clarifying expectations, showing consistency, or just being open about how you like to work.
Fostering respect and professional courtesy can go a long way in keeping the peace and may even help to mend a rocky relationship. When that rapport is there, it makes even the hard days feel more manageable, and the good days feel like shared wins.
Weathering the Good and The Bad
At its best, an NP–physician relationship is a partnership grounded in shared goals and mutual respect. At its most challenging, it can test your patience, confidence, and energy. Most relationships fall somewhere in between. When colleagues are getting you down, what matters is protecting your peace, learning to coexist where you can, and attending to your duties with clarity and care.
