Nurse Practitioners: Growing Need, Responsibilities, and Practices

     With the growing primary care physician shortage discussed in last week’s articles, there is a debate emerging about whether nurse practitioners can and should step in to ease the pains of the primary care physician shortage. In this two-part blog, we will be discussing the way in which nurse practitioners can be used to help patients and ease the physician shortage as well as the possible concerns that may arise if nurse practitioners step into this role.

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     Three concerns associated with having nurse practitioners practice without a supervising physician include:
   
     1. The amount of clinical hands-on training done prior to entering practice.
         When nurse practitioners reach the point of certification, they have acquired between 500 and 1,500 hours of clinic training while a family physician, newly graduated, has more than 15,000 hours of hands-on clinical training in addition to 4 years of medical school. Furthermore, a 2004 survey published in the Journal of American Academy of Nurse Practitioners concluded that nurse practitioners do not feel ready for solo practice after the formal certification process.

     2. The degree of education and ability to handle complex cases.
         Nurse practitioners are trained to recognize and treat common health problems such as strep throat and ear infections as well as to monitor certain chronic conditions such as hypertension. They also often educate patients about chronic conditions, medications, nutrition and exercise. However, primary care physicians are trained to diagnose and treat more complex and difficult cases. Physicians receive training and education beyond that of nurse practitioners, thus giving them the ability to spot more difficult and complex cases.

     3. The price of a nurse practitioners can be deceiving for the healthcare industry as a whole.
         On the surface, it seems as though nurse practitioners are lower cost than physicians because they are paid less and fees paid by third-party payers are lower for nurse practitioners than their physician counterparts. However, often, nurse practitioners will order more tests and consult with specialists more often than resident physicians and attending physicians as found by a study in the journal, Efficient Clinical Practice. A less knowledgeable clinician will order more tests or consult with specialists more because of their uncertainty. The increased fee for tests and consultations offset the amount saved by using nurse practitioners as opposed to physicians.

     Tune in Friday, February 10th for the second part of this blog discussing the many ways nurse practitioners can help ease the burden of the primary care physician shortage.