Why Doctors Are Wrong To Oppose More Authority For Nurses

(Credit: The Telegraph)

Doctors are reluctant to give nurses more authority to treat patients, according to findings in a New England Journal of Medicine study released on Wednesday. But doctors’ skepticism about nurses having expanded roles isn’t based on the facts — and it ignores the reality that nurse practitioners must take on such responsibilities if health care reform is to succeed.

The new study finds that many doctors don’t trust nurses to lead patient-centered “medical homes,” with only 17 percent of surveyed primary care physicians viewing it positively. “Medical homes” are arrangements encouraged by Obamacare in which nurses, doctors, pharmacists, and specialists work together to provide patients with better and more efficient care in a unified setting.

There is also a striking chasm between doctors and nurses on the issue of nurse practitioners’ ability to provide safe, quality patient care:

When researchers asked whether they felt the quality of care provided by physicians in exams and consultations was higher than that provided by nurse practitioners, more than 66 percent of doctors agreed, while 75 percent of nurses disagreed.

Doctors also overwhelmingly disagreed with many nurses’ position that they should receive the same level of pay as doctors for performing similar services.

But this position is an untenable one in the era of Obamacare, with more than 25 million Americans expected to gain health coverage in the coming decade. Since the bulk of these Americans are expected to consume primary care — rather than specialty — services, it’s important that the U.S. medical system have enough medical workers to serve them. And there simply aren’t enough primary care doctors to tackle that burden on their own.

Instead, nurse practitioners will have to take on additional responsibilities. There’s no reason to suspect that this will compromise patient care quality — in fact, multiple studies have shown that the quality of care that nurse practitioners provide for acute primary care is on par with doctors. One randomized trial comparing nurses’ versus doctors’ ability to manage complex care regimens for HIV-positive patients receiving antiretroviral therapy also found no evidence of professional inferiority. As David Hebert, CEO of the American Association of Nurse Practitioners, told Kaiser Health News, “[N]urse practitioners have been practicing safely and providing great outcomes for decades.”

Doctors — and patients — would be well served by an expanded role for nurse practitioners. Primary care doctors tend to be concentrated in urban areas, creating a major barrier to rural and isolated communities’ access to basic medical services. But nurses are more numerous and could have greater access to such populations, making them ideal candidates for heading medical homes and seeing to the day-to-day aspects of patient care.