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AAFP: PCMHs should not be led by nurse practitioners

The patient-centered medical home (PCMH) is the future of healthcare in the United States says the American Academy of Family Physicians (AAFP) - but only if PCMHs are led by doctors.

The AAFP has spent many years supporting the PCMH model, and its new report, “Primary Care for the 21st Century,” continues the association’s argument that team-based care is the best model in the market today and should be what the industry moves toward in the coming years. PCMHs, the paper says, bring down the cost of care and provide improved quality and access to care.

However, while the AAFP praises the team-based approach of PCMHs, the organization asserts that PCMHs can only be truly successful if they are led by physicians. The report singles out advanced practice registered nurses (nurse practitioners) as being inappropriate caregivers to lead a team-based care model or practice without the oversight of a physician.

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

“The rationale behind most proposals to allow nurse practitioners to practice independently is that the nation is facing a primary care physician shortage,” the AAFP says in the report. “This is true. But substituting NPs for doctors cannot be the answer. Nurse practitioners are not doctors, and responsible leaders of nursing acknowledge this fact.”

“This movement for nurses to treat patients without a physician comes at the same time that medical practice itself is changing to a team-based approach. These two approaches take this country in opposite and conflicting directions,” said Roland Goertz, MD, chair of the AAFP’s board of directors. “Granting independent practice to nurse practitioners would be creating two classes of care: one with physician-led teams and one guided by less-qualified health professionals. Americans should not be forced into this two-tiered scenario. Everyone deserves to be under the care of the physician.”

The debate to allow nurse practitioners to practice independently has been a contentious one across the country. The AAFP, a physician membership organization, has long argued against it, saying that NPs do not have the clinical training to practice independently.

Proponents say independently practicing NPs provide high-quality care at lower costs and take exception to the AAFP’s continuing fight against the licensure of independent nurse practitioners.

“The American Academy of Nurse Practitioners strongly supports patient-centered and team-based care models. However, AANP believes that AAFP’s efforts to link these evolving models of care with the licensure of nurse practitioner (NP) practice are misdirected and out of step with today’s environment,” said Angela Golden, AANP’s president, in a statement reacting to the AAFP’s report.

“For nearly half a century, NPs have been providing quality care and offering increased healthcare access to millions of patients. More than 100 studies analyzing care provided by both NPs and physicians have demonstrated that NPs have the same or better patient outcomes when compared to physicians,” Golden’s statement continued. “The ongoing attempts by the AAFP to limit the ability of NPs to practice to the full extent of their education and training only serves to increase the already overwhelming hardships placed on millions of Americans who are struggling to gain access to high quality healthcare.”

More than 20 states allow for licensure of independent nurse practitioners. While the AAFP continues to argue against the independent practice of NPs in states where licensure has not been granted, the organization is not calling for states that have allowed the practice to repeal licensure.

Nor is the AAFP calling on Congress to rewrite the parts of the Affordable Care Act that allow primary care providers – not just physicians – to form PCMHs, saying the organization would rather lawmakers focus on supporting PCMHs and the primary care workforce as a whole.


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