30
The nurse practitioner will see you now
Program assistant Mayra Dittman (R) helps Juanita Gilbert walk to the restroom at the Lifelong Medical Marin Adult Day Health Care Center on February 10, 2011 in Novato, Calif.
To view this content, Javascript must be enabled and Adobe Flash Player must be installed.
It can be tough to see a primary care physician today. Just wait till next year when another 30 million patients or so get insurance under Obamacare.
“We need all hands on deck. We need more family physicians. We need more primary care nurse practitioners, we need more physicians assistants…we need pharmacists. Everyone with a focus on the patient,” says Dr. Wanda Filer, a physician in York, Penn., and board member of the American Academy of Family Physicians.
The nation is facing a shortage of primary care physicians. Estimates range from several thousand today to 52,000 by 2050. Annual spending on primary care is approximately $200 billion.
Not surprisingly, nurse practitioners, physician assistants, pharmacists and others are raising their hands to help fill the growing gap in coverage.
Nurse practitioners like Andrea Vettori who runs the Mary Howard Health Center in Center City, Philadelphia. Vettori says if she sees a patient outside her scope of practice, she will refer the patient directly to a specialist. There’s no need for a primary care physician in the equation.
“People talk about the future of health care and NP filling the role of the primary care provider, physicians becoming specialists. I don’t see any reason why that couldn’t be,” she says.
Rand Corporation health economist David Auerbach says there’s good reason for primary care doctors to be looking over their shoulders. Nurse practitioners can treat 85 percent of what a primary care doctor can treat.
“The number of primary physicians is growing very slowly. And the number of NPs is probably going to double in the next 15-20 years,” he says.
All this isn’t lost on powerful medical organizations like the Family Physicians and the American Medical Association. Those groups say providers should work together -- as a team -- so long as physicians run the ship.
Bring on the turf war.
“Currently there are 12 states with active legislation looking at utilizing nurse practitioners at the top of their education to meet patient care needs,” says Tay Kopanos with the American Association of Nurse Practitioners.
She says nurses want to end laws that require some level of physician oversight, like for prescriptions or diagnosis.
Doctors say they aren’t opposed because they’re afraid other medical providers will steal their jobs. They say they’re concerned about patient safety. What if there is a complex case and the nurse practitioner misses something?
“I see it as physicians being true to their oath. And being true to their training and education. And I think most physicians feel that way. They are not threatened by this. At the end of the day what they want to do is deliver the best healthcare possible,” says Dr. Adris Hoven, president-elect of the American Medical Association.
Dr. John Rowe at the Columbia School of Public Health dismisses those concerns. He says nurse practitioners are already working without primary care doctors.
“The fact is this is going on in 16-17 other states and there is no evidence that it’s not good for the patients,” he says.
As a doctor himself, Rowe gets why doctors are concerned.
“The physicians feel they have something special to offer. And being told there are individuals who are less well trained can do it as well as they could is a very difficult lesson for them,” he says.
But Rowe says if doctors and nurses can’t come together to solve the primary care shortage, that could be a painful and expensive lesson for all of us.
Pages
- ‹ previous
- 1
- 2
- 3
- next ›
This is good news for patient care. Studies show that patients are highly satisfied with the care they receive from NPs and we are already responsible for our practice and outcomes. NPs - just like primary care physicians- will continue to refer patients outside of our scope of training or expertise to be seen by specialists as needed. That won't change when we are given the freedom to practice independently.
I am also a family physician and work as an equal with PAs and NPs in a federally-qualified health center. I have two comments...
This model can be extrapolated to many other fields of medicine. There are certified nurse anesthetists that can do much of what anesthesiologists are trained to do. Similarly, certified nurse midwives and pediatric nurse practitioners have many of the same competencies as OB/GYNs and pediatricans, respectively. I will not be surprised if we see a similar trend in some of these other specialty areas. I guess we will see how powerful those lobbies are, because incomes are generally higher for these groups of physicians.
Second, many nurse practitioners and physicians assistants specialize in surgery, dermatology, gastroenterology, etc., just like their physician colleagues. This is just human nature. Income and hours are better and primary care can be very challenging. With this in mind, PAs and NPs may not be a comprehensive answer to our primary care shortage.
The comparison of NP or the like doing the work of a physician is misguided. This is a great show but at times, the generalizations just don't cut it. Yes, i am a physician. If it's possible to provide the same care with 1/2 to 1/3 of the training, then all physicians in this country are vastly over trained. Since no one seems to think that, i simply don't understand how someone who did much less basic science learning and much less clinical work can come out with equal competency. I don't see any NP programs go through the equivalent of 4 yrs of medical school nor do i see any of them have 3 yrs of 80 hr work weeks with patients as a residency equivalent. Unless you want to assume that the schools that train NPs and RNs attract a much higher caliber or intellectually strong individuals, the only conclusion that can be drawn that a) MD/DO schools attract a dumber subset of individuals than NP schools b) Physicians are vastly over trained c) this debate is created by powerful NP and RN lobbies who want to do play physician without the appropriate training d) the payer (be it government or private insurer) is creating a parallel system and making it appear equivalent, such that 20-30% of physician salaries can be "saved" and physicians are forced to take lower payments. Physician salaries account for 10-15% of healthcare expenditure. Would you want to pay what you are paying for healthcare today and be forced to see an NP who has less training than someone who is in his first year of medical residency and worse understanding of pathophysiology to go along with it?
That's a question that everyone needs to answer for self. I certainly would not.
Just a few comments in response to this from a current NP student:
1. I am at an Ivy League institution and competed against hundreds of other outstanding candidates to come here, and my cohort is full of high caliber, intellectually strong individuals with a stunningly diverse array of life experiences to bring to their studies. I would put any of us up against any of the med students at this school in a battle of intellect and understanding. Our guest lecturers often come from the medical school, our anatomy class was taught by somebody from the med. school, and I would say that we are getting a superior education for what we are going to be doing.
2. It is not a question of smart versus dumb, but a question of which philosophy of care you subscribe to. Nursing emphasizes treating the whole person, or whole family, and it emphasizes wellness, preventive care, and empowering individuals to take charge of their own health. My perception of doctors is that they are trained in recognizing and treating pathologies. My goal as an NP is to provide care for people such that they never develop the pathologies in the first place. If 1 in 7 healthcare dollars in this country is spent on treating chronic disease, then we need to address these issues BEFORE people get the Type II diabetes or CAD diagnosis. NPs can do that (come on, you know this next part is true), boring, less well-remunerated work that I do not see medical students signing up for in droves. Not many med students want to be Marcus Welby anymore.
3. NP residencies are becoming increasingly common and available. I am all for an extra time after school to work under supervision, especially if it is paid the way that residencies for doctors are paid.
4. I would highly encourage the original poster and any other doctors who are skeptical about the value of NPs to talk to us, find out what we can actually do, instead of just assuming that NPs are not adequately trained. Collaboration and dialogue will advance the healthcare of the citizens of the US much faster than engaging in turf wars and belittling.
3 points-(to Wisdom) 1. It seems to me that with regard to education there is the discussion that is part of the national agenda about DECREASING the amount of time one needs to spend to become a family Physician AND utilizing FMGs that in some cases don't have the background that US physicians have has been looked at too as a way of solving this storm/crisis that is bearing down on our healthcare system (to many patients, not enough providers)...this has been put worth by some very educated physicians. 2. There many strong studies out there that show what NPs know and can do, that show that ability to diagnose in the primary care setting is equal to that of the family physician...studies published in physician peer reviewed journals. 3. We are not discussing if they (NPs) can do it, in 16 states they are already doing it and another interesting point is that in a hospital setting in NYS a physician can have a collaboration agreement with 20 NPs and/or PAs, no one would logically assume that there is close daily ties with that many collaborations. At the end of the day we all collaborate...all of us. There will be many issues in the future, lets not draw the line here. I believe there was a time when allopathic medicine looked at osteopathic trained physicians and said "Are they safe..." In the interest of full disclosure I am an NP and for the last 4 years I have been successfully performing as a lone nocturnist/house officer in a community hospital. When I collaborate it is with the same people that most physicians would collaborate with (cardiologists, nephrologists...etc.). I look forward to working with you sir!
Change is always scary!
Well, Marketplace/NPR has so many stories that start with "Nurse Practitioners and Physician Assistants" and then go on to only look at the NP side of the story. As a PA in practice for over 25 years [wow, time files!], I have to agree with Dr Messner's comment below. We are both trained in intensive, shorter programs than physicians. We DON'T know as much. We are trained to know what we don't know. PAs have always been comfortable with being dependent practitioners. We have never argued for independent status.
Please try to find and interview PAs for your next NP/PA story.
Catherine, PA's do not have a spotlight on them at this particular time, but, I can assure you, that if NPs are allowed to practice at the height of their license, PA's will follow suit. PA's are paramount in the reshaping of American healthcare! Yes, we are different on some level, but not much.
More access to nurse practitioners (NPs) might be especially helpful if they are not affiliated with doctors groups. After all, one of the big expenses in health care is all those people who go to the emergency room not because they have emergency needs, but simply because there are no clinics available at odd hours. But a groups of NPs might find their niche by offering extended hours, or weekend hours, or services in more out-of-the-way places.
It is also possible that an NP clinic might specialize a bit. In modern medicine we are seeing more and more use of algorithms, in order to decide on the appropriate drug or therapy or diagnosis. And so, in certain fields, the nurses might actually provide very good specialized care, before having to send the patient on to a doctor specialist.
Of course this doesn't work out so well when the nurses cost more than pediatricians or veterinarians, as they do in my part of the woods!
Pages
- ‹ previous
- 1
- 2
- 3
- next ›
