On Wednesday, the American Academy of Family Physicians (AAFP) circulated a new Ipsos poll to reporters declaring “Americans Overwhelmingly Prefer Physicians For Their Medical Care.” The poll pointed out that “73% of adults… prefer to take a loved one to a physician over a nurse practitioner.” But those findings directly contradict another recent survey from the American Association of Nurse Practitioners (AANP). Just last month, AANP claimed there’s “widespread, national support among the general public for legislative and policy proposals that give patients access to nurse practitioner care and services.”
Ultimately, the conflicting studies underscore a contentious issue that has broad ramifications for how Americans will be able to access primary medical care in the coming years, as the health reform law takes full effect.
As millions of Americans gain insurance for the first time under the Affordable Care Act, nurse practitioners (NPs) and physician assistants (PAs) will likely need to help manage larger patient loads in the face of a possible primary care doctor shortage. These non-doctor caregivers could be particularly helpful in rural and isolated regions that don’t have many practicing physicians. For instance, if NPs and PAs were allowed to serve as primary care providers who manage patients’ basic needs, they could prescribe medications without having to get permission from a doctor first. Expanding nurse-managed health centers and medical homes could cut the expected doctor shortage in half, according to a study from the RAND Corporation.
“Growing use of new models of care that depend more on nonphysicians as primary care providers could do much to reduce the nation’s looming physician shortage,” wrote lead study author David Auerbach. “But achieving this goal may require changes in policy, such as laws to expand the scope of practice for nurse practitioners and physician assistants, and changes in acceptance, on the part of providers and patients, of new models of care.”
NPs and PAs have more experience and education than general nurses, and most of them hold Master’s or doctorate degrees. NPs tend to have over ten years of nursing experience before entering practitionership, and “must hold previous nursing degrees to qualify for the graduate programs as well as professional nursing experience prior to entering school,” according to the Washington Post.
Nonetheless, physician groups have generally been opposed to state-based measures that expand nurse practitioners’ and physician assistants’ ability to practice primary care and lead collaborative, patient-centered “medical homes.” In fact, about two-thirds of doctors said they felt the quality of care provided by physicians in exams and consultations was higher than that provided by nurse practitioners and that NPs shouldn’t receive the same level of pay as doctors for providing similar services in a recent survey; three in four NPs disagreed with that assessment.
Doctors’ dour assessments of the care provided by nurse practitioners isn’t really backed up by the data. Several studies have concluded that “no differences were found between [the groups treated by physicians and those treated by NPs] in health status, disease-specific physiologic measures, satisfaction or use of specialist, emergency room, or inpatient services.”
“[N]urse practitioners have been practicing safely and providing great outcomes for decades,” said AANP CEO David Hebert in an interview with Kaiser Health News.