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Nurses' Role in Primary Care Access Critical, But Constrained

Cora Nucci, for HealthLeaders Media, November 10, 2010

Even for a healthy person with private insurance living in a major metropolitan area, finding a primary care physician who is taking new patients can be a lengthy ordeal.  When one is found, a typical response from the doctor's office might be: "She's booking well-visit appointments 18 months out." 

Some people find their spouses and start a family in less time.

For someone living in a rural community, the difficulties of finding primary care are even tougher. Physicians are scarcer than in cities and the geographical distance between patient and provider may be great.

There is, however, a pragmatic way to augment basic primary care services.

I'm talking about loosening restrictions on the 160,000 nurse practitioners in the U.S., so that they may take on some of the tasks of primary care physicians. No one is advocating for nurses to open craniums or resect colons at will, or to do any of the other work that only highly trained physicians can do.

What nurses with advanced training and certification want to deliver, and what patients in rural areas need, is greater access to primary care.

But don't take their word for it (or mine). Look at the findings of the Institute of Medicine after it examined how nurses can help attain the objectives of the 2010 Affordable Care Act. The two-year study culminated in the report, The Future of Nursing: Leading Change, Advancing Health

One of the IHI's key recommendations:Nurses should be full partners with physicians and other healthcare professionals in redesigning healthcare in the United States.

In many states, certified registered nurse practitioners are already alleviating the case load of primary care physicians. But in states such as Alabama, regulations under which NPs may practice are so onerous that they need an MD to sign off on physical therapy orders for patients. That's not right.

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