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Nurse-Practitioners: The Answer to the Doctor Shortage?


Let's do the math: We have nearly 30 million uninsured people about to get medical coverage under the health care law come January. And we have a projected shortage of 45,000 primary care physicians by 2020. Add to that the American Association of Nurse Practitioners (AANP), with 43,000 members who say they can offer basic care if state laws would just let them set up an independent practice without doctor supervision.

And the answer is ...

The nurse-practitioners, of course, say it's a matter of simple addition: New laws are needed to give them more autonomy.

But doctors say it's a miscalculation to think that patient safety won't be compromised by not having a doctor overseeing things. Family physicians have more than four times as much education and training, accumulating an average of 21,700 hours, whereas nurse-practitioners receive 5,350 hours, the American Academy of Family Physicians points out.

Others question whether this is a situation of the health care industry looking for cheaper labor to provide services to patients. Pricier specialists have been providing 40 percent of primary care visits, studies show, although the number of medical-school graduates going into primary care is slowly rising, according to  USA Today.

But with the health care deadline looming, a new push has been launched in about a dozen states to allow nurses with a master's degree or higher to order and interpret diagnostic tests, prescribe medications and administer treatments without physician oversight, the Washington Post reports.

"We have a ready-made, no-added-cost workforce in place that could be providing care at a much higher level if we modernize our state laws," Taynin Kopanos, vice president of state government affairs for AANP, told the Post. "So the question for states is, are you going to fully deploy this resource or not?"

Doctors say their opposition isn't because they're worried about keeping their jobs; they're concerned about patient safety. A nurse-practitioner could miss something crucial in a patient with complex symptoms.

"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 health care possible," Ardis Hoven, M.D., president-elect of the American Medical Association, told the radio show Marketplace.

But John Rowe, M.D., of the Columbia University Mailman School of Public Health, told Marketplace that nurse-practitioners are already working without primary care doctors: "The fact is, this is going on in 16 to 17 other states, and there is no evidence that it's not good for the patients."

The Post story noted that the health care law itself encourages the creation of nurse-run practices by requiring insurers to pay nurses the same rates they pay doctors for the same services, starting next year. Medicare, however, will still reimburse nurses at 85 percent of the doctors' rate.

Photo:  ernstl /flickr


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