¶ … Nurse Practitioner Affect the Shortage of Primary Care Physicians? Can the Nurse Practitioner Affect the Shortage of Primary Care Physicians?

Topic Background and Issue Introduction

The objective of this work in writing is to examine the issue of whether the Nurse Practitioner can affect the shortage of primary care physicians? Specifically this work will examine whether Nurse Practitioners can improve access to care and fill the void of the primary care physician shortage. It was stated in the American College of Clinicians position statement released October 14th, 2009 that it has become clear that the American healthcare system "is in need of an overhaul. Current figures indicate that there are over 46 million people who are uninsured. This equates to 15% of nation's citizens who may not be able to access health care." (American College of Clinicians, 2009) The American College of Clinicians states that it "submits that Physician Assistants (Pas) and Nurse Practitioners (NPs) already significantly improve access to primary care services, but are underutilized in our current health care delivery system." (2009) There is reported to have been a "systemic failure to recognize that the skills and knowledge of PAs and NPs makes them well qualified to fill the role of primary care provider." (American College of Clinicians, 2009)

II. Analysis and evaluation of Issue

The American College of Physicians states in a 2000 publication that it recognizes that "NPs and physicians have common goals of providing high-quality, patient-centered care and improving the health status of those they serve. In addition, physicians and NPs share concerns regarding appropriate reimbursement for services provided, especially related to care coordination, and the decline in the primary care workforce." (American College of Physicians, 2000) For this reason, it is important to acknowledge the "critical role that NPs play in improving access to care." (American College of Physicians, 2000) The stated reasons that this position is held by the American College of Physicians are stated to be those as follows:

"Position 1: Physicians and nurse practitioners complete training with different levels of knowledge, skills, and abilities that while not equivalent, are complementary. As trained health care professionals, physicians and nurse practitioners share a commitment to providing high-quality care." (American College of Physicians, 2000)

The American College of Physicians states that when it is possible that the patient's needs and preferences should be met "by the health care physician with the most appropriate skills and training to provide the necessary care." (2000) In the case of patients with problems that are complex such as multiple diagnoses and cases where there are challenges due to difficult management of cases it is stated that these cases are likely to be served best by the physician and a team of health care professionals such as the nurse practitioner and other nonphysician clinicians. (American College of Physicians, 2000, paraphrased) The American College of Physicians states that the patient has the right to be made knowledgeable about the credentials of the individual that makes provision of their care.

The National Organization of Nurse Practitioner Faculties states the specific domains and core competencies for the Nurse Practitioner Practice as well as for programs that lead to the NP degree in the primary care specialty areas of adult health including family health, gerontological health, pediatric health, and women's health. The competencies are stated to be inclusive of: (1) health promotion/protection/prevention; (2) management of patient illness; (3) the nurse practitioner-patient relationship; (4) the teaching-coaching function; (5) professional role; (6) assisting patients in managing and negotiating health care delivery systems; (7) monitoring and ensuring quality health care practice; and (8) having cultural and spiritual competence. (Division of Nursing, Bureau of Health Professions, U.S. Department of Health and Human Services, 2002)

The work entitled "More Nurse Practitioners Could Take On Primary Care Responsibilities" states that nurse practitioners are expected to play a larger role in the provision of primary care services "as California health systems take steps to develop...

states that allow nurse practitioners to provide some aspects of primary care services without the supervision of a physician. There are presently six regions in California that have a shortage of primary care physicians. (California Healthline, 2011, paraphrased)
According to report, nurse practitioners 'have advanced degrees and can perform many of the duties of primary care physicians. They also generally cost less to train and are easier to recruit." (California Healthline, 2011) It has been twenty years according to one reported since a doctor has practiced in Armstrong County in the Texas panhandle and in fact, it is reported that "all states face some physician shortages." (CSC.org, nd) For example in Idaho, "approximately one-third of the state's 44 counties have been designated Health Professional Shortage Areas by the federal Health Resources and Services Administration (HRSA)." (CSC.org, nd) Specifically stated is that "sixty-million people -- approximately one-fifth of the country's population-reside in more than 3,000 shortage areas. The lack of doctors in those places has dramatic consequences to access to medical care." (CSC.org, nd) It is reported that the shortage of physicians in areas that are underserved is likely to worsen before it improves. (CSC.org, nd, paraphrased)

It has been proposed by the American Association of Medical Colleges that enrollment in medical schools should be increased by 30% by 2015 through expansion of existing medical education programs." (CSC.org, nd) Kaiser Health News reports that American Medication Association "sparked harsh criticism from nursing groups when it released a report in October bluntly questioning whether nurse practitioners "are adequately trained to provide appropriate care." (Villegas, 2010)

The National Conference of State Legislatures work entitled "nurse Practitioners as Leaders in Primary Care: Current Challenges and Future Opportunities" reports that six nurse-managed health centers "…consistently scored better than the aggregate on outcomes measures collected…" (National Conference of State Legislatures, 2010) In addition, it is stated that there are presently an approximate 80,000 nurse practitioners making primary care provisions. (National Conference of State Legislatures, 2010, paraphrased)

The report of the Michigan Health Council (2010) It is reported that registered nurses who desired to be nurse practitioners are required to procure nursing specialty certification from the state with requirements being: (1) a valid RN license and (2) proof of certification from a national certifying agency. (Michigan Health Council, 2010) In the State of Michigan, it is reported that 49% of nurse practitioners work in family practice and have 10 years of experience in their practice while 18% of nurse practitioners in the state of Michigan work in adult primary care and have an average of 11 years experience. . (Michigan Health Council, 2010) The category with the least nurse practitioners is that of oncology with only 1% of nurse practitioners working in this area and having only 8 years of experience in their practice. (Michigan Health Council, 2010, paraphrased)

III. Solutions, Implications and Conclusion

Dr. Timothy Christian states that one approach to the problem would be to "…create a primary care physician education track into which students could be admitted directly. Students in this track would be funded for the full amount of tuition for four years in exchange for an extended period of practice in general internal medicine, family practice, or pediatrics." (2010) As stated by Christian (2010) $150 billion was spent by the government to bail out GM and to aid A.I.G. And $140 billion has been spent annually fighting wars in Iraq and Afghanistan, therefore it appears the government should place just as high priority on healthcare of U.S. citizens.

The Kaiser Family Foundation Issue Brief released March 2011 states n some integrated health care systems (both public and private) noted for the quality of care they provide, NPs play a major role in providing primary care. The Veterans Health Administration, a system that emphasizes primary care, including care coordination and disease management, hires NPs…