Apr 20, 2015
When allowed to practice to their full ability, nurse practitioners could fill a huge void left by a shortage of primary care doctors.
This post was written by Julie Sweet from 2U. At eMedCert, we strongly encourage all forms of guest posting. If you are interested in publishing your work on the eMedCert blog, please contact our editorial team at [email protected].
Primary care is facing significant problems. Fewer young physicians are choosing to enter family medicine, instead opting for higher paying and glitzier specialty roles. Established primary care physicians are getting older, and many are starting to consider retirement. Add to that a graying and growing population, and the United States is left with an accelerating need for primary care services, but fewer physicians willing to provide them. By 2020, the Bureau of Health Professions is predicting a shortage of more than 20,400 primary care physicians.
Photo by: Ideal Healthcare Solutions
Time to panic? Not quite. Rather, now is the time to call on nurse practitioners — a proven group of health care providers who are ready, willing and more than able to step forward and provide the primary care that physicians are not.
Five Decades of Quality Care
Although nurse practitioners have largely gone without the prestige typically awarded to physicians (when was the last time you saw a NP-parking-only section in the hospital parking lot?), they’ve been an important part of the healthcare picture for decades. The first NP program launched in 1965 and, since then, the profession has grown to number more than 200,000 licensed nurse practitioners in the United States alone.
A type of advanced practice nurse, nurse practitioners are RNs who pursue further training in master’s (MSN) and practice-doctorate (DNP) programs to learn how to provide both primary and specialty care to patients in line with a holistic nursing model. Many provide care in primary care practices alongside physicians and other members of the modern healthcare team. Some NPs even own their own independent practices.
Research shows that nurse practitioners effectively shoulder some 80 to 90 percent of care traditionally provided by primary care physicians. Studies also consistently show that nurse practitioners are popular with patients, providing outcomes and satisfaction rates easily on par with those scored by physicians. What’s more, nurse practitioners are already a staple in many underserved areas, urban and rural alike. Primary care nurse practitioners are much more likely than their physician counterparts to provide care to vulnerable populations, such as patients who are poor or who lack insurance, in a variety of community settings.
Plentiful Providers, Cost-Effective Care
An additional advantage of tapping nurse practitioners to fill anticipated primary care gaps is their reduced preparation time. It takes roughly 6 years to train an NP (4 years in a BSN program plus an additional 2 years in an MSN program), compared with double that for physicians. Between 2010 and 2020, the Health Resources and Services Administration projects the supply of primary care nurse practitioners is expected to grow by almost one-third. If used effectively, the growing NP population, combined with similar projected increases in the physician assistant population, could drop the expected primary care shortage from 20,400 to just 6,400 providers.
Nurse practitioners also offer value. Simply put, care offered by nurse practitioners typically costs less. One Massachusetts report found that patient visits with NPs cost 35 percent less than visits to physicians. At an annual average salary of about $99,000, nurse practitioners cost practices almost half as much as family physicians, who earn an annual average of $189,000.
Outdated Constraints Hinder Opportunity
So what’s stopping nurse practitioners from stepping in and providing care where their services are needed? In some states (such as Washington, Colorado, and Maine), nothing. In others, outdated, physician-centric laws and policies unnecessarily impede NPs’ ability to practice to their full extent.
Consider this observation made by the Institute of Medicine in 2011: “What nurse practitioners are able to do once they graduate varies widely for reasons that are related not to their ability, education or training, or safety concerns, but to the political decisions of the state in which they work.”
In 20 states and the District of Columbia, nurse practitioners are legally allowed to practice to the full extent of their training. The remaining states, however, continue to require physician collaboration or supervision for NPs to legally perform specific tasks they are already trained to perform independently, such as prescribing controlled substances or ordering certain diagnostic tests.
By unnecessarily requiring physician involvement, state policies are hindering primary care NPs at a time when primary care physicians are disappearing. That’s why the Institute of Medicine as well as numerous other NP supporters are now saying it is time to do away with scope-of-practice barriers and increase NP autonomy.
As the Institute of Medicine puts it, nurse practitioners “have the opportunity to play a central role in transforming the health care system to create a more accessible, high-quality and value-driven environment for patients. If the system is to capitalize on this opportunity, however, the constraints of outdated policies, regulations and cultural barriers, including those related to scope of practice, will have to be lifted.”
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