Nurses and physicians are at odds over who is qualified to take the lead in caring for the expected surge of newly insured Americans that will strain primary care providers.
A study commissioned by the American Academy of Family Physicians shows 72% patients prefer physicians over nurse practitioners for their medical care.
"We decided in the setting of everybody talking about patient-centered medical homes and transforming healthcare that it would be really important to go out and ask patients what they thought about how their healthcare is provided, says Reid Blackwelder, M.D., president of AAFP. The survey of 1,363 adults was taken in early November.
The American Association of Nurse Practitioners, also curious about what type of care patients want, released its own study last month showing that healthcare consumers are in favor of expanding responsibility for NPs.
The two surveys do not exactly contradict each other, but it does indicate the two sides—nurses and doctors—are digging in their heels over who is qualified to take the lead in caring for the expected surge of newly insured Americans that will strain primary care providers.
According the AAFP survey, only 7% of respondents said they would prefer a nurse practitioner over a physician while 16% indicated no preference and 5% said they didn't know.
The AANP is continuing its lobbying efforts for states to give NPs more authority to prescribe medication, order tests, provide some services for some Medicare patients, and practice without a physician's supervision. Easing scope-of-practice restrictions, would address the shortage of primary care physicians.
AANP Co-president, Ken Miller, in a statement last month, pointed to its own survey results showing that 70% of patients are supportive of NPs having more responsibility, as proof that patients' preferences skew favorably toward NPs.
"These results clearly confirm what we have known anecdotally for years: American healthcare consumers trust NPs and want greater access to the safe, effective services they provide. This is no surprise given that NP patients have health care outcomes that are consistent with those of physicians, and that patients consistently, and increasingly, prefer NPs as their primary health care provider."
Concluding that because Americans support legislation expanding NP authority, they also prefer an NP over a physician is a long leap. But patients, whether faced with access or insurance challenges, have been increasingly turning to NPs and other non-physician providers.
Take a look at the growth in retail clinics at pharmacy chains. What started out as stopping in to pick up a prescription or a flu shot has morphed into a convenience store with a healthcare department.
Now you can see someone (a non-physician provider) about a cold or minor ailment while also picking up a gallon of milk and your prescription and getting a flu shot. Consumers have become increasingly comfortable with this model, but physicians are uncomfortable with the lack of communication among the different parties providing care.
"The reality is that some medical issues can be provided in different locations, [such as] flu shots," says Blackwelder, who is also a practicing family physician in Kingsport, TN.
"The challenge is it goes back to the fragmentation of the system. I don't know, in Kingsport, if my patient has gotten the flu vaccine somewhere else. Part of this transformation to team-based care is making sure we have systems in place so that accessing healthcare is communicated back to my office because again, I'm the physician leader of the team and I want to know what's going on with my patients."
Blackwelder, and the AAFP, for that matter, are not anti-NP. Non-physician providers have an important role to play as part of a team, he says.
"The survey demonstrates patients overwhelmingly want to see physicians… almost three-quarters want to see a physician for their healthcare needs, and nine out of ten want a physician to be a leader of that team, and that's an aspect that's not usually a part of retail clinics," says Blackwelder.
He believes solving the problem of the primary doc shortage will come from payment reform and restructuring the healthcare system to a team-based approach. Doctors have been waiting on the former for nearly 10 years, and the latter is far off.
With more patients and healthcare consumers soon expected to fill providers' waiting rooms, demand may drive preference. And it is likely to happen before the industry is ready.
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Jacqueline Fellows is a contributing writer at HealthLeaders Media.