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Policy brief examines nurse practitioner debate

With concern over primary care shortages not likely to abate any time soon, the debate over using nurse practitioners to fill in the gaps continues. A new policy brief released by Health Affairs last month outlines the issues.

“The importance of primary care and anticipated shortage of access to primary care services is a critical issue as we look forward to full implementation of the (Affordable Care Act),” said the brief’s author, Amanda Cassidy, principal of Meitheal Health Policy. “This brief was intended to give policymakers, journalists and others an understanding of competing arguments related to expanding the role of nurse practitioners to better meet the demand for primary care.”
While Cassidy stressed that the brief provides a “balanced discussion of the debate” by explaining the arguments for and against expanding the role of NPs to allow them to provide a wider range of services, the available research, as noted in the brief, does not support claims by physicians arguing against an expanded role for NPs.

[See also: AAFP: PCMHs should not be led by nurse practitioners .]

Doctors, Cassidy wrote in the brief, argue that encouraging patients to seek primary care from NPs rather than primary care physicians “may put patients’ health at risk.” Doctors stress the many more years of education and depth of training they have in comparison to NPs to support their reasoning, but Cassidy noted in the brief that “the evidence does not support these claims.”

[See also: Nurse practitioners fight for more independence, doctors resist.]

The evidence, as noted in the brief, does appear to support expanding the role of NPs. “Studies comparing the quality of care provided by physicians and nurse practitioners have found that clinical outcomes are similar,” Cassidy wrote in the brief.

As a whole, the studies have found that health status, treatment practices and prescribing behavior were consistent between NPs and doctors; that patients seeing NPs report higher levels of satisfaction with their care; and that NPs score better on measurements related to patient follow up, time spent in consultations and provision of screening, assessment and counseling services.

[See also: MGMA conference panel discusses the state of healthcare.]

Furthermore, the brief notes, NPs are paid less than physicians for providing the same services.

Ultimately, it will be up to state legislatures to decide, noted Cassidy in the brief’s conclusion. “In considering changes to licensure and scope-of-practice requirements, state legislatures will weigh concerns from physicians about patient safety and try to discern whether these concerns have any validity or primarily represent a concern about competition,” she wrote.


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