Speaking at a think tank in Washington, DC and citing a report titled “Nurse Practitioners: A Solution to America’s Primary Care Crisis,” Buerhaus told the audience nurse practitioners (NP) are ready and able to help fill the health care access gap created by the ongoing shortage of primary care doctors in the United States.
The report, which partially relies on data from an annual forecast published by the Association of American Medical Colleges (AAMC), predicts a shortage of 40,800 to104,900 physicians by 2030, and Buerhaus says the the shortage will likely substantially widen over the next decade because of the rapidly increasing health care needs of the Baby Boomer generation and an expected loss of 49,000 primary care physicians.
To alleviate the predicted shortage of primary care providers, governments should reduce or eliminate onerous NP licensure requirements and regulations, Buerhaus says.
Nurse practitioners should be allowed to evaluate patients, diagnose conditions, order and interpret diagnostic tests, and initiate and manage treatments, including prescribing medications and controlled substances, Buerhaus told the audience at the American Enterprise Institute in September.
Changing Roles
Joyce Knestrick, president of the American Association of Nurse Practitioners, says government rules regulating nurses and physicians, don’t reflect today’s reality.
“From the very beginning, nurses were supposed to be independent of physicians,” Knestrick said. “But when the field of nurse practitioner started, many recognized there was a need for better primary care … to aid in answering questions about primary care and addressing some of the problems with acute care, so we began to see ‘advanced practice’ roles [for nurses].
“Many times the restrictions on what nurse practitioners could do were there because of pushback from organized medicine, not issues to protect the public,” Knestrick said. “That caused state boards to come back and look at the scope of nurse practitioner services. Regulations began to be changed.”
Knestrick says states vary greatly on how much physician supervision they require for nurse practitioners.
“In 28 states, we have two different categories: one we call restricted, and one we call reduced,” Knestrick said. “There are 16 that have what we call reduced practice, and those states require a collaborative agreement [with another health provider] that varies from state to state. There are 12 states that are restricted states, and those require supervision by a physician.”
Learning from UK’s Mistakes
Charlie Katebi, a state government relations manager at The Heartland Institute, which publishes Health Care News, says the United States’ current primary care doctor shortage is similar to what has long plagued the United Kingdom. U.S. policymakers should learn from the United Kingdom’s errors instead of repeating them, Katebi says.
“The United Kingdom is unveiling a plan that would allow individual doctors to see as many as 15 patients at a time to address the doctor shortage problem,” Katebi says. “This reveals an unsettling truth about government-run health care: Some American proponents of socialized medicine praise single-payer countries like the United Kingdom for allotting so little of their national budget to pay for health care, but they never talk about the fact that their budget for health care is so low because they’ve made it much harder for doctors to deliver health care to patients.
“That’s what’s happening in the United Kingdom, where health care is planned, financed, and delivered almost exclusively by the National Health Service, an agency that meets its budget only by routinely underpaying providers and denying reimbursements for critical services patients need,” Katebi said.
Katebi says nurse practitioners are fully qualified to take on greater autonomy in treating patients, to help ease the primary care shortage and prevent the United States from repeating the mistakes of the United Kingdom.
“Nurse practitioners are registered nurses with education at the master’s level or higher,” Katebi said. “They are more than qualified to provide all sorts of primary care services, including diagnosing and treating many common illnesses and prescribing medications. A 2013 review of 26 peer-reviewed studies in the journal Health Affairs found that patients treated by nurse practitioners had the same health outcomes as those treated by physicians.”
Quality, Affordability
Knestrick says patients can expect the same quality of care with a nurse practitioner, and generally at a lower cost.
“Studies show we provide high-quality, low-cost care, especially compared to physicians,” Knestrick said. “We come from a nursing model, so we are more holistic in our care, and we are more cost-effective because we understand the patient and their social issues. We order less tests, and we tend to have a patient-centered approach.
“I think patients are choosing nurse practitioners because they have the same high quality of care but we offer accessibility and we focus on taking care of the needs of the whole patient,” Knestrick said.
Buerhaus’ research indicates more than 84 million Americans live in Primary Care Health Professional Shortage Areas, areas designated by the Department of Health and Human Services as having shortages based on geography, population, or availability of facilities. A disproportionate amount of those lacking access to quality care live in rural areas, where NPs are uniquely well-suited to practice. Knestrick says policymakers can provide relief to these underserved populations simply by increasing NPs’ allowed scope of practice.
“There is a disconnect with policymakers regarding how and if nurse practitioners are allowed to practice autonomously,” Knestrick said.
