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Future key Role of Nurse Practitioners in Primary Care

Posted Oct 28 2012 12:00am

I have come to believe that nurse practitioners (NPs) will function, even more than today, as key players in the delivery of primary health services (see: A Solution to the PCP Shortage: Nurse Practitioners ). My prediction is based on the following facts: (1) ever more training is increasingly the choice for most young physicians because of the higher remuneration and the greater ability to control working hours; (2) the work of a primary care practitioner (PCP) is not perceived as a satisfying career role for many young physicians. Because of these factors as well as others, primary care physicians are chronically in short supply. A recent NYT piece addresses this issue from the perspective of nurse-managed clinics (see: The Family Doctor, Minus the M.D. ). Below is an excerpt from it. It's a long piece so read it in its entirety for more details than I can provide here:

The Family Health Clinic of Carroll County, in Delphi, Ind., and its smaller sibling about 40 minutes away in Monon provide full-service health care for about 10,000 people a year, most of them farmers or employees of the local pork production plant....Doctors are trained to focus on a disease. Nurses are trained to think more holistically. What these clinics don’t offer are doctors. They are two of around 250 health clinics across America run completely by nurse practitioners: nurses with a master’s degree that includes two or three years of advanced training in diagnosing and treating disease. By 2015, nurse practitioners will be required to have a doctorate of nursing practice, which means two or three more years of study. Nurse practitioners do everything primary care doctors do, including prescribing, although some states require that a physician provide review. Like doctors, of course, nurse practitioners refer patients to specialists or a hospital when needed. America has a serious shortage of primary care physicians, and the deficit is growing.....Obamacare will bring 32 million uninsured people into the health system — and these newbies will need a lot of medical care. According to the American Association of Medical Colleges, the United States will be short some 45,000 primary care physicians by 2020. The primary care physicians who do exist are badly distributed — 90 percent of internal medicine physicians, for example, work in urban areas. Some doctors go to work in rural areas or the poor parts of major cities, treating people who have Medicaid or no insurance. But they are few. In part it’s the money. Primary care doctors make less than specialists anywhere, but they take an even larger financial hit to treat the poor. 

The movement toward NPs as major providers of primary care is inexorable and will be largely unopposed politically. I don't think that physicians have as powerful a lobby today as in former years. Organized medicine would have previously fought a trend like this vigorously. In fact, I suspect that many physicians today favor the NP movement. Regarding politicians and their support for this movement, they can count votes. There are an estimated 352,908 primary care physicians in the US today (see: Medical Schools Can't Keep Up ). For 2008, there were an estimated 3.1 million RNs (see: How many nurses are there? ).

The average salary for nurse is less than most MDs, although this differential may not last for long, given the requirement that a doctorate in nursing for NPs will be required by 2015. Most importantly and as noted in the article, the influx of new patients in our healthcare system will require a rapid increase in health professionals. We need personnel to manage minor ailments and also to triage patients to our very highly trained speciality physicians. This triage can be enhanced by the use of computer algorithms. NPs and other nursing personnel are the obvious choice to serve in this capacity.

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