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  • Nurse Practitioner

     

     

    By Michele Pedulla, DNP, RN, ARNP, CPNP-PC; Google+ Profile
    Faculty Member, Kaplan University School of Nursing
     

    The nation is facing a growing shortage of primary care physicians. Are nurse practitioners the answer?

    When 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.

    According 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.”

    The 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.

    With 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.”

    The Doctor Deficit 

    Exactly 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.

    Several 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.

    At 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 wait times.

    And 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.

    These 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.”

    Curbing the Crisis 

    In 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.

    Nurse 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.

    Family 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.

    Burk 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.”

    But, 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.”

     

    Michele 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 Kaplan University.

     

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