Group Says Community-Based Nursing Model Could Boost Primary Care Coverage

HealthLeaders Media Staff, May 11, 2009

In light of growing shortages of primary care physicians across the country, the role of community-based nurses needs to be reexamined during the healthcare reform debate, according to an American Academy of Nursing (AAN) group.

Without changes soon, various areas could experience "Massachusetts-style growing pains," in which consumers have difficulties finding primary care physicians when they seek medical services, said Donna Shalala, the former Health and Human Services secretary, who spoke Friday as part of AAN's "Raise the Voice" campaign that she chairs.

This shortage of physicians is likely to escalate—possibly resulting in a shortage of 44,000 physicians by 2025—in the areas of general internal medicine and family medicine, said Tine Hansen-Turton, JD, who is CEO of the National Nursing Centers Consortium in Philadelphia.

At the same time, 80,000 (out of about 145,000) nurse practitioners are providing primary care—becoming one of the fastest growing groups of primary care professionals nationwide, Hansen-Turton said. Now may be the time to "think outside the box" and increase reliance on non-physician groups such as nurse practitioners and physician assistants, and expand to nontraditional settings such as nurse-managed health centers and convenient care clinics.

The nurse managed health center could be a solution, for instance, for primary and preventive care in areas serving low income and vulnerable populations, said Hansen-Turton. Currently, more than 250 of these community-based centers exist throughout the country in various urban, rural, and suburban locations—but their "true potential" remains untapped, she added.

Most of these centers are either independent nonprofits or academically based clinics, Hansen-Turton said. The centers, which last year recorded 2.5 million patient visits, generally are staffed by nursing practitioners, clinical nurse specialists, registered nurses, healthcare students, and collaborating physicians.

In Pennsylvania, nonphysician healthcare models were established about two years ago. The state's governor, Edward Rendell (D), said that the project, called "Prescription for Pennsylvania," has been able to help patients with chronic care problems receive treatment and assist them through a patient-centered medical home model.

While increasing access to health insurance will help improve access to healthcare, more recognition is needed of nurse practitioners' roles in providing primary care and expanding access, according to Shalala, who is currently president of the University of Miami. Keeping this in mind, nurses "need a seat at the table" during the current healthcare reform debates and more federal attention in terms of funding for the health centers.

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