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Nurses Replacing MDs as Front Line Primary Care Providers.

Posted Dec 23 2008 9:14pm
I n the face of a continued primary care provider shortage the debate goes on between nursing and medicine as to each other's roles in delivering patient care. Advanced practice nurses becoming an initial point of contact for most patients while a general practitioner physician serves a referral source for more complex medical cases is being debated now - Science Daily. The usual points are raised with respect to training and abilities of the two providers.

Bonnie Sibbald, Professor of health services research at the National Primary Care Research and Development Centre, University of Manchester.

"...substituting nurses for doctors has the potential to improve the efficiency of primary health care. Too often GPs provide the same services as nurses and this leads to duplication rather than substitution of care. In fact, she says, GPs skills would be better used to tackle more complex health problems which have a higher degree of uncertainty about their diagnosis and treatment."

"...acknowledging nurses to be the true frontline providers of primary care"& [while the] "general practitioners' role should evolve to become that of a consultant in primary care receiving referrals from nurses"."

There is no doubt about the contributions that mid-level providers offer to the world of primary care. Clearly my position is somewhat biased with respect to having advanced practice nurses more deeply involved in the delivery of care. The big issue here is one of turf wars from the MD side. Nursing from its inception has taken a subservient position in health care. Many will argue the differences in training between an MD and an Advanced Practice Nurse as the basis for keeping the status quo and maintaining nursing's backseat position in the care arena.

While some MDs may feel somewhat insulted in taking referrals from RNs, the goal here is not to engage in ego wars but to improve the access to quality care through any all means available. A collaboration of expertise which health care education programs preach ad nauseam needs to be more than just lip service in today's health care world.
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