Can NPs Solve the Primary Care Shortage? Readers Weigh In

Brandon Cohen

Disclosures

December 12, 2018

In a recent article on Medscape, registered nurse Troy Brown explored the notion that states should allow nurse practitioners (NPs) to assume an expanded role in primary care as one way to address the current shortage of primary care physicians.

This opened the door to lively and occasionally acrimonious debate about the proper roles of physicians, nurses, and physician assistants.

Quite a few respondents believed that giving NPs more responsibility would be a valuable step toward providing much-needed care to underserved communities.

One NP kicked things off:

[I have worked in a rural area] for almost 20 years. I have seen many physicians come and go soon after their loans are paid off! I have stayed. The care I provide to my patients increases access, reduces costly emergency room visits, and provides patients a choice of their provider type . . . I've been through hurricanes when the power has been lost [and still saw] patients. My clinic is not fancy but provides accessible cost-effective care in communities where patients save both time and money...The MD-led model does not work! Many patients in rural America have no MD. Instead, we need to embrace an "all hands on deck" approach.

Another nurse faced similar challenges:

Every day I see patients coming to the emergency room because either they cannot afford to see a primary care provider because of lack of insurance or they have to wait weeks before seeing their doctor... People are dying because of lack of care; many times it is too late by the time they come to the emergency room.

But a medical student worried about the capabilities of nurses:

The truth is that modern physician training differs significantly from the uncontrolled and unstandardized chaos of on-the-job training—a core feature of non-physician pathways.

Another medical student concurred:

If you want to practice as a physician and have those practice rights, then go to medical school. If you want to be an NP or PA and have the responsibilities associated with those licenses, go to PA or NP school. The schooling is different, the credentials are different and are tied to the number of hours of basic science education and clinic training.

But a registered nurse cited the surprising opinions of her neurologist daughter in support of nurses:

She [the daughter] repeatedly expounds on how nursing students compared to medical students are held to higher study and testing hours and standards than medical students... who know they can slough off a lot because they do not risk being expelled for poor work, low grades, or much else. Whereas, nursing students are evaluated over and over, endlessly, to make sure they know their stuff.

A medical student replied with a harsh metaphor:

The lengths the nursing propaganda train will go to prove their equivalence is relentless and unsafe.

A wry primary care physician also joined the discussion:

While we're at it, let's teach barbers how to take out gallbladders. It will be much less expensive than a full boarded surgeon.

Another physician felt threatened:

NPs are in fact out to take physician jobs. It takes longer and costs more money to train a physician than it does a nurse. What happens in a competitive environment when one group has a higher barrier to entry than its competition? It dies out.

But a nurse responded:

No, we are not out [for physicians' jobs.]... There are plenty of jobs for physicians. The competition you speak of is created by physicians and their schooling. It is of their own making. Until this is resolved, NPs will be utilized more and more to meet the demand by our public who seek healthcare services.

An administrator looked for other solutions:

Maybe instead of burdening physicians with 50% downtime for non-value-added paperwork and treating that like it is the norm, we should trim that down to a reasonable amount. Suddenly our shortage would seem much more manageable.

A nurse continued this line of thinking:

Look at the reality of how a physician's time is wasted on things that could easily be handled by a PA or NP. How many people go to the ER with an ear infection, a rash, a kidney stone? What is the hourly dollar value of a physician in the ER? Waste drives increased costs that affect us all. I say, utilize every health care worker to the maximum of their education and capability. A nurse should not be making copies or restocking shelves, but we do. What a waste. Smart resource utilization would benefit everyone.

And a physician wondered whether money could solve the problem:

The commonsense approach to the primary care shortage is to pay physicians better to do the job, period.

The final word goes to a nurse who called for unity:

I have worked with wonderful MDs, PAs, and NPs. I truly believe we all can be part of the solution instead of trying to bring each other down... at the end of the day, patients are suffering and dying because of lack of primary care.

The full article can be found on Medscape.

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