States Consider Expanding the Nurse Practitioner Role


Physicians generally are not supportive, so the turf battle continues.

In response to the anticipated shortage of primary care physicians in the near future, 28 states have introduced legislation that expands the authority and scope of practice of nurse practitioners (NPs). And with 32 million more Americans expected to have health insurance coverage in the next few years, there is increased interest in utilizing NPs to provide healthcare. Not surprisingly, the medical community (namely the American Medical Association [AMA]) is generally not supportive and are lobbying to protect what they consider to be their turf. The AMA has gone so far as to say that expanding the role of the NP will endanger patients. However, an often cited study compared NPs and physicians who were randomly assigned to care for more than 1,300 patients. After six months, patients' overall health, utilization rates of diabetes and asthma tests, and number of referrals to specialists were essentially the same in both groups.

NPs are highly educated and well qualified to provide care that falls within their scope of practice. NPs do not want to practice medicine, nor do they. While some refer to NPs as "mid-level providers," NPs fill the gaps where physicians often do not want to practice. These gaps may be geographic; NPs are often the only healthcare providers in rural America, or they may be gaps in practice; physicians for the most part prefer not to work in school or family planning clinics.

Another gap though is the economic gap. Medicare currently pays NPs 85% of what it pays physicians. Fortunately, this gap is being recognized---and questioned. The new healthcare legislation gives nurse midwives equal pay to what obstetrician-gynecologists make.

The nonpartisan Macy Foundation, a New York-based charity that focuses on the education of healthcare professionals, recently called for NPs to be among the leaders of primary care teams. The foundation also urged the removal of state and federal barriers preventing NPs from providing primary care. This is a huge step in the right direction.

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