Saturday, March 19, 2011

Advanced Practice Nurses to Fill the Gap in Primary Care

There’s a frightening scenario that looms ahead in the near future, one where there are not enough primary care physicians to provide care for those who need it. According to the American Association of Family Physicians, there will be 40,000 less primary care doctors less than necessary in ten years’ time. This is because there are not enough medical students choosing to enter primary care when other more lucrative specialties beckon, at least not enough to keep pace with the number of primary care providers who are retiring from active practice or leaving the field for other reasons. 

The jury is still out on whether advanced practice nurses (including DNPs and NPs) can efficiently fill this ever-widening gap in primary care, but with the US Department of Health and Human Services setting aside as much as $15 million to set up new clinics that will be completely run and managed by nurse practitioners, perhaps the future will see APNs taking a more active role in providing primary care to the citizens of our country. 

There are many advantages to this decision to allow APNs more autonomy in the way they practice medicine:
·        They are known to spend more time with patients, and they are already used to taking down patient history and providing follow up care. Patients feel more comfortable and satisfied when they perceive that their care provider is spending more time with them. 

·        Reimbursements for nurse practitioners and other advanced practice nurses in primary care is much less than that for primary care physicians, so it’s a win-win situation all round because NPs and DNPs are more in demand, physicians are free to carry on with other specialized tasks, patients spend less on healthcare, and the overall cost of healthcare comes down over a period of time.

·        With more people dedicated to providing primary care, diseases and illness come down with preventive care, chronic diseases become easier to manage, and general wellbeing and health improve with more people becoming aware of the importance of a good diet and regular exercise after spending quality time with their primary healthcare provider.

However, there is resistance to the idea of ANPs being allowed to run their own primary care show as opposed to being supervised by doctors – physicians insist that it’s not a case of protecting their turf but one of safety and patient concern; with physicians spending more than 150,000 hours of practice before they set out on their own and ANPs getting only 1500 hours of training, the difference is stark, according to the detractors of this idea.

But with over 24 states allowing NPs to set up their own clinics and practice without the supervision of a doctor, it seems that the future of primary care belongs to ANPs. And with the Institute of Medicine agreeing that to meet the increased demand for primary care, limits on nurses’ scope of practice should be removed; it’s a good time to consider becoming an ANP. 

This guest post is contributed by Paula Dierkins, who writes on the topic of Online PhD Degree . Paula can be reached at her email id: paula.dierkins[@]gmail[.]com


o.O said...

Argh. NO. Please, I believe in nurses who are as good as doctors, but I feel they don't have enough training and schooling. If it's "typical" things, but doctors who go to medical school learn more of the atypical things and can see signs. Then again, I had experiences with PAs and nurses trying to diagnose something and when I finally talk to the head doctor, or can pin point it out.

Then again, some times, I don't believe in formal schooling.

Anonymous said...

The question remains, how much of that 150,000 hrs are spent working side by side with Patients. On an average of 90% or more, physicians rely on the epertise of the clinical nurse in pulling out clinical data so they can form their diagnoses. Nurses are only able to do so through an indepth understanding of disease and management. So truly, if we were to evaluate what APNs do and get trained, the average APN have clocked over 8 years of bedside nursing, and that comes out to a far more than 150,000 hours of clinical hands on training. So the answer lies in the detail of those clinical hours clocked. Who do you think trains those young residence at the bedside and gets them to focus on the real issues at hand. Nurses, do.

To Anonymous Above said...

An APN who has clocked 8 yrs of bedside nursing is not comparable to a doctor who has clocked 8 yrs of work....

Anonymous said...

I'm sorry, but bedside nursing experience is just not the same as handling and actually managing a myriad of complex problems that a patient is facing. Nurses have a good perspective of bedside caring, usually one patient at a time, but that is much different from the above. For example, I don't know how many nurses and ANPs will automatically think that a ring-like skin lesion is some time of fungus, will give anti-fungals and move on believing that was a simple case to be handled by a simple NP. MDs are trained to see the differential- to know that it could also be nummular eczema, contact dermatitis, or a number of other diagoses, and to consider these. Nurses just do not have the in-depth training that doctors do. And of course, a nurse with 30 years of experience will have something to teach a recently graduated medical student who is just getting on her/his feet as an intern. we all learn something from everyone. That does not make us equivalent.