mead cohen berger shevtsova garfinkle michta grygiel blankenhorn
Nurse Practitioners Are Key to Health Care Reform


We’re so focused on bad health care reform at the moment that we may be overlooking the positive possibilities right in front of us. At the American Prospect, Amelia Thomson-DeVeaux rehearses many of the benefits of giving nurse practitioners greater independence: they can provide the same level of primary care as a physician but at a lower cost; a wider scope of practice for them could greatly ameliorate the emerging primary care shortage; most Americans are fine seeing an NP for basic care. But legal barriers are preventing the health care system from reaping these benefits, and, as Thomson-DeVeaux points out, a big force behind keeping those barriers in place is doctors’ lobbies:

Not all doctors’ groups are opposed to expanding NPs’ scope of practice. But according to Molly Cooke, the president of the American College of Physicians, much of the problem is cultural—doctors aren’t used to thinking about NPs or PAs as peers. Part of the problem, she says, is the structure of medical school. “There are lots of things that nurses and NPs do better than physicians,” she says. “It might be very reasonable for a medical student who’s learning about how you support a patient’s coping skills to learn that from a nurse. But a medical student will say, no, I’m a medical student and I want to be a supervised by a physician.”

But doctor’s lobbies aren’t the only thing holding back better scope of practice laws; bad health care reforms have also distracted us from putting momentum behind better primary care policies. The grand principle that should inform all health reform is that America needs to figure out ways to improve care delivery at a reduced cost. For one thing, that would make it easier and less expensive to provide health care for those who can’t afford it. VM supports the goal of universal coverage, strongly, but to get there we need smart health care reforms, like enhanced use of NPs.

Unfortunately, after Obamacare we’re sunk in the muck of trying to fix a broken fix to a broken system, when our energy should be devoted to forging fresh solutions.

[Photo of stethoscope and money courtesy of Shutterstock]

Features Icon
show comments
  • Corlyss

    “But legal barriers are preventing the health care system from reaping these benefits.”

    I’ve been watching the old 70s show Emergency for about a month now. I was completely addicted when it was in first run. One of the fascinating aspects was how resistant the doctors were to letting PMs make even simple and obvious treatment decisions without close supervision by a doctor. The prohibitions were built into the enabling legislation that created the PM force. The pilot for the show centered on the difficulty of convincing the medical community that all those battlefield trained and tested medics from Viet Nam War were capable of handling the responsibility and the pressure without compromising patient care. Indeed, the whole idea was that the PMs improved the survivability of accidents if they were allowed to do certain high-reward low-risk activities immediately during the golden hour as opposed to trying to stabilize the victim without the techniques.

    In a two-parter now running on METV, the LA lads are sent to Seattle to observe how things are done there. Apparently Seattle had a much more victim-friendly and less doctor-centric approach even then. Their PMs were allowed to do minor surgery as the occasion called for, transport in their own rescue ambulances rather than wait for private ambulance services to collect the victim, and, if I heard correctly, thoracotomies, while the California laws still required their PMs to leave those techniques to doctors and private services.

    Now, in the 1970s doctors riding along on every medical emergency was out of the question for several reasons, money and availability reasons if no other. Obamacare has threatened the pool of doctors available to the system as if it were a curious disease that struck only doctors and eliminated them at alarming rates. Many eligible to retire are just leaving the system rather than suffer under the regime. There will be even fewer doctors to tend to the sick and injured when we’re already in the midst of a decades long doctor shortage. The test for the nurse practitioner will be in the state by state legislative battle to determine how willing the powerful doctor lobby will be to relinquish authority to non-physicians. We’ll just have to see. Since little the doctor lobby does has much to do with patient care and is mostly centered on keeping their fees high, or at least high enough to make a living on, it will be an interesting 50-state battle.

  • DirtyJobsGuy

    I’m not so sure the impact is as big in non-injury cases. My experience with Nurse Practictioners is that they were often more conservative than MDs. They would recommend/order more tests and initial intervention. I think the MD has both more experience and authority that allows a more realistic approach. That said, allowing NP’s to do more initial triage on injuries is well worth it.

  • Maynerd

    I responded to a prior WRM post touting the cost savings of NP’s with the following:

    I am a specialist MD and not a primary care physician. Count me as skeptical that large savings exist using mid-levels (NP’s and PA’s) as surrogate primary care physicians. My specialist colleagues all bemoan the unnecessary imaging, lab work, and specialty consultation generated by the relatively insecure and inexperienced mid-levels. It would be interesting to add up the total global cost to the health care system of a mid level vis a vis an MD.

    The premise that a few years of training is equivalent to 4 years of uber intense medical school and three additional years of residency is comical.

    On the positive side NP’s and PA’s can at least partially compensate for the predicted shortage of primary care physicians. But the costs savings are a mirage and the precision and accuracy of care will not be consistently first rate.

  • Scott Kirwin

    This is bollocks. First off there is no PCP shortage. There is a shortage of PCPs willing to work for $35-$50/hr, be treated as drug dispensers by their patients, document writers by the insurance companies, and overpaid morons by their nursing staff. Shortages work themselves out; they don’t need gov’t or anyone else interfering with them.

    Secondly the AAFP found that the average family doctor receives 21,700 hours of training versus 5,300 for a nurse practitioner. 99% of the time the differences won’t matter but who is more likely to catch the problem if your in that 1%? The truth is though that the war between the FPs and NPs is misguided. 41% of primary care is provided by specialists treating patients who skip the gatekeepers because their insurance allows it, and they don’t have to pay the cost difference between the PCP and the specialist. Remove that and the lot of the PCP might begin to improve.

© The American Interest LLC 2005-2016 About Us Masthead Submissions Advertise Customer Service