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.

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.

About the author

Dan Gorenstein is the senior reporter for Marketplace’s Health Desk. You can follow him on Twitter @dmgorenstein.

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