NPs Top Physicians in Small Patient Satisfaction Survey

Mark Crane

June 27, 2011

June 27, 2011 — Nurse practitioners (NPs) outscored physicians in a patient satisfaction survey among low-income primary care patients in Michigan, according to researchers at the American Academy of Nurse Practitioners (AANP) 26th Annual Meeting in Las Vegas.

The survey, released Friday, found that only 50% of physician patients reported that they felt that doctors "always" listened carefully, compared with more than 80% of NP patients.

The US Agency for Healthcare Research and Quality's Consumer Assessment of Healthcare Providers and Systems questionnaire was given to a random sample of 97 low-income NP patients and 99 low-income physician patients in Flint, Michigan. All patients were aged 16 to 62 years and were enrolled in a county-funded public healthcare plan.

For 15 of 18 core questions, "the difference in satisfaction between patients in the NP and physician groups was significant, all in favor of NPs," study researcher Susan Lyons, RN, MSN, from the University of Michigan in Flint, said in a news release.

"Nurse practitioners in the study scored extremely well because they are culturally competent healthcare providers and expert communicators," Constance J. Creech, RN, EdD, lead study author and assistant professor of nursing at the University of Michigan, told Medscape Medical News. "Physicians actually scored very well, too, but the difference between the groups was significant."

NPs topped physicians in the percentage of patients who found that "things were explained in a way that was easy to understand," received easy-to-understand instructions, felt the healthcare provider showed respect for what they had to say, and thought the provider spent enough time with them, Dr. Creech said.

"This adds to the evidence that NPs are able to work independently," Lyons said. "Patient satisfaction comes from respect and listening, fewer hospitalizations, and fewer prescriptions. This is just more proof NPs can operate effectively independently without supervision by physicians."

Time May Be a Factor

One reason for higher patient satisfaction is that "nurse practitioners generally spend more time with patients than physicians do," Jan Towers, PhD, NP-C, director of health policy for AANP, told Medscape Medical News. AANP represents more than 135,000 NPs practicing in the United States.

Michigan doesn’t allow independent practice by NPs, but bills are pending in the state legislature to change that. "Removing barriers to allow NPs to practice to the full scope of their abilities is an important step in solving the primary care physician shortage problem in Michigan," Dr. Creech said.

Nationwide, most NPs work under the supervision or guidance of physicians, but in one third of the states NPs can practice independently, Dr. Towers said.

"Physicians need to be open to hearing that they aren’t being perceived by patients as listening carefully," Glen R. Stream, MD, president-elect of the American Academy of Family Physicians and a family physician in Spokane, Washington, told Medscape Medical News. "Patient satisfaction is an important metric for quality of care, but it’s just one metric. The actual quality of care delivered is most significant."

Dr. Stream noted that the survey sample is quite small. "It’s a stretch to extrapolate the findings across the country," he said. "It’s a real leap to take these results and say they support the independent practice of NPs. AAFP favors an integrated team-based environment where all health professionals work alongside physicians, who can supervise and be available as back-up. We want to provide the best possible care for patients and not get involved in turf battles with NPs or anyone else."

The official AAFP position is that nurse practitioners should "only function in an integrated practice arrangement under the direction and responsible supervision of a practicing, licensed physician." AAFP represents 100,000 physicians and medical students nationwide.

American Academy of Nurse Practitioners 26th Annual Meeting. Presented June 24, 2011. Abstract 1080.

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