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Learning Center Experience
By Michele Pedulla, DNP, RN, ARNP, CPNP-PC; Google+ ProfileFaculty Member,
Kaplan University School of Nursing
nation is facing a growing shortage of primary care physicians. Are nurse
practitioners the answer?
most people have an illness like a cold or a symptom such as a sore throat
that’s gone on for several days, they usually take a trip to the doctor’s
office. But, with an ever-increasing shortage of primary care physicians in the
United States—and demand for them increasing every year—it’s getting harder these
days for patients to find a doctor nearby, let alone secure a same-day appointment.
So, what’s a sick person to do? As it turns out, more and more folks are turning
to their neighborhood nurse practitioner to treat their medical needs instead.
to the National Nursing Centers ConsortiumConvenient Care Association, an arm
of the Public Health Management Corporation, approximately 20 million patients have sought the care of nurse practitioners in 2013.Nurse practitioners are registered nurses who hold a
master’s or doctoral degree, with advanced training in a specialty area, such
as family medicine. “They’re trained to do physical exams, diagnose, treat,
assess, and prescribe,” explained Ken Miller co-president of the American Association of Nurse Practitioners
(AANP) and a professor at the Catholic University of America’s School of
Nursing, to Kaplan University “They can do 85% to 90% of what a family practice
physician does, essentially.”
AANP estimates that there are more than 189,000 nurse practitioners providing
care in the country today. That’s up from 128,000 in 2008. The RAND Corporation, a nonprofit research organization, predicts the number will rise
to 244,000 by 2025. A majority of those in the field today work in primary
care. Many collaborate alongside doctors in private practices or in community
health centers, some lead nurse-managed clinics, and others provide services at
retail clinics, such as those in CVS and Walgreens.
an influx of people entering the nurse practitioner profession each year, some health
care experts say expanding the roles of nonphysician providers, such as nurse
practitioners and physician assistants, could potentially ease the expanding
primary care gap. “Nurse practitioners represent 189,000 possible solutions to
the country’s current primary care crisis,” Miller said. “Can we alone solve the
problem entirely? No—but we can help.”
what kind of deficit are we looking at? Forecasts by the Association of American Medical Colleges say the nation faces a
shortage of 91,500 physicians across all specialties by 2020, including 45,000
primary care physicians. By 2025, the country is expected to be short 130,600 physicians.
factors are contributing to the widening gap. For one, baby boomers are aging.
Over the next decade, the U.S. Census Bureau
estimates a 36% growth in the number of Americans over age 65—the very
demographic with the greatest health care needs. The physician population is
getting older, too. Nearly one third of all doctors are projected to retire over
the next 10 years. Plus, millions of newly insured Americans under the Affordable
Care Act means that millions more people are expected to be seeking care.
the time of this writing, nearly 60 million Americans lacked adequate access to
primary health care due to a scarcity of providers in their communities. Perhaps
the most visible example of the shortfall’s impact is the burgeoning VA scandal.
In May 2014, the Department of Veterans Affairs blamed an acute shortage of 400
primary care doctors for excessive treatment delays experienced by veterans across
the nation—which then reportedly led certain facilities to falsify records of
veterans aren’t the only ones affected by the shortage. Residents of rural and inner-city
areas have been feeling the strain for years. Often, those living in areas with
limited primary care resources are forced to travel long distances to see a
doctor. This can lead to them delaying or even forgoing care, and can result in
a patient’s condition worsening or even a pricey trip to the ER—all things that
can be avoided with greater access to providers.
are the types of situations where nurse practitioners can make a great impact.
“Nurse practitioners are playing a vital role by making patient-centered care
available in rural and underserved communities,” George Zangaro, director of
the National Center for Health Workforce Analysis in the Bureau of Health Workforce, told Kaplan
University. Zangaro, who supports a team-based approach to tackling the primary
care crisis, added, “One of the most important services being provided in these
areas is health promotion and disease prevention, which will decrease the
incidence rates of diseases and hospitalizations.”
an effort to offset the shortage, 19 states plus the District of Columbia have
passed legislation increasing the scope of practice for nurse practitioners. These
laws allow nurse practitioners to provide services with less physician
oversight, practicing closer to the full extent of their education and
training. More states are considering moving in this direction as well. However,
some physician groups argue that substituting nurse practitioners for doctors isn’t
the answer. The American Academy of Family Physicians has been vocal about its
opposition, citing questions of patient safety and quality of care as a concern.
practitioner advocates say there is no data to support those claims. In fact,
says AANP’s Miller, studies over the years have found the quality of care
provided by nurse practitioners comparable to that of family physicians. The same
studies also found that nurse practitioners were given equal or even higher marks
in patient satisfaction, likely due to the fact that they are able to devote
more time to each appointment. Research published last year in the journal Health
Affairs has also shown that, while most patients still prefer to see a
doctor for their medical needs, they are happy to see a nurse practitioner or
physician assistant if a doctor is unavailable.
nurse practitioner Bessie Burk told Kaplan University that she likes to spend at
least 10 minutes with each of her patients. Burk works at the Sun Life Family
Health Center in Casa Grande, Arizona. Arizona is one state that grants nurse
practitioners full-practice authority. On any given day, Burk sees about 25 to
30 patients, some scheduled and some walk-ins, for issues ranging from minor colds
to chronic diseases. Compare this with the doctors at the Center, who see at
least 40 patients daily.
said the additional time allows her to build extra trust and a rapport with her
patients. She also said her work as a nurse has trained her to better educate patients
on how to take care of themselves. “Our patients like us. They can talk to us.
When we sit down together, they just have a better connection with the nurse
part of us,” Burk explained. “We absolutely
make a difference in these communities.”
to make a difference on a national level, said Miller, nurse practitioners in every state must be allowed to practice
with full authority. And, echoing Zangaro, he added, “We need to stop looking
at this as a single discipline issue. This crisis concerns all health care
providers. It’s going to take all of us working together to solve it.”
Pedulla is a full-time faculty member at Kaplan University. The views expressed
in this article are solely those of the author and do not represent the view of
Colleen Dutile Faculty Story
Barbara Erickson Student Story
Master of Science in Nursing Program
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