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Family Physicians Rap 'Stopgap' Use of Nurse Practitioners

John Commins, for HealthLeaders Media, September 24, 2012

"We talk about independent practice as the ability and responsibility of any provider to use the knowledge skills judgment and authority that they have to practice to the full extent of their licensure and education. That is true about anybody, registered nurses, psychologists, pharmacists. This report sets up a false dichotomy between team-based care and APRN's practicing 'without a physician on staff.' "

"That is an odd way to frame it, because when we talk about meeting the needs of patients, anybody who has experienced the healthcare system realizes there is no one individual provider who can do everything a patient needs."

Summers says nurse practitioners are well equipped to provide primary and preventive care and manage chronic diseases and when the needs of the patients fall outside of their expertise they will refer to a physician, just like a family physician will refer patients to a specialist.

"It no more reasonable to talk about APRNs practicing without a physician on staff than it would be to talk about a family physician practicing without a cardiologist on staff," she says.

Goertz says much of the tension in the scope-of-practice debate is found at the 20,000-foot-level between rival policymakers, and not at the point of care delivery, where "you have these understandings in place."

"If you are talking about on-the-ground activity where the teams are taking care of patients, there is not a lot of contentiousness about this. Everybody understands the patient is the focus of attention. In the actual act of delivering care, I don't see a line-in-the-sand problem," he says.

"Where I see it is in the higher level of leaders of some nursing schools who want to essentially change the model of care delivery and they have already succeeded in doing that to a certain extent. Our issue is that there is not one single profession that can solve this problem. We all need to work together and the patient-centered medical home is a far better model than simply expanding nurse practitioners."

That is all we are trying to say. Since there is a difference in education and training, we need to honor those differences and work within them."


John Commins is a senior editor with HealthLeaders Media.

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2 comments on "Family Physicians Rap 'Stopgap' Use of Nurse Practitioners"


Dee Swanson DNP FNP (9/25/2012 at 12:55 PM)
There is no data or research that documents the need for the length of time that a physician must study before becoming competent to provide primary care. The is more than ample data that supports the safety and competence of NPs as providers of primary care. This is about power, control, turf and money as it always is with physicians.

Dr Reg Broekmann (9/25/2012 at 3:21 AM)
In South Africa we are piloting a new PHC system in which PHC nurses are connected to a designated Family Health Practitioner via a sophisticated communication system. Clinical discussions result in learning and improvement on PHC nurse competence and referrals are authorised by the Family Health Practitioner. The FHP then can monitor the progress of each referral and will give feedback to the PHC Nurse on the final diagnosis and treatment - another learning experience.