Sunday, September 30, 2012

Nurse Practitioners and Primary Care

Stephen L. Brotherton, MD
Fort Worth Orthopedic Surgeon

In a Sept. 14 guest editorial in the Fort Worth Star-Telegram, Sandy McCoy, a Plano nurse practitioner and president of the nurse practitioners’ state association, fashioned a plea for increased scope of practice for her profession. She made several correct statements that are worth repeating: Texas is low compared with other states in availability of primary care physicians, and it is undoubtedly going to get worse; there are not enough Texas medical residency slots to further the training of Texas medical school graduates; and, in her words, “nurses are crucial to the future of healthcare in our state.” She also quotes one of several economic models that show a positive economic impact to fully actuating primary care in the state.

However, she makes one statement that is arguable and leaves out two important factors. She asks for significantly increased ability to diagnose and prescribe — duties traditionally held by doctors — and states that such is “well within the bounds of (nurse practitioners’) education and training.” She is welcome to make that plea, but it is enough to say that not every stakeholder within health care would agree with her. She also fails to note that the shortage in access to health care is primarily rural, and that there is a chronic and recurring shortage of nurses functioning in their traditional role. Her solution would not address the first issue, and would tend to aggravate the second.

Nurses are an indispensable part of the health care team. Think about it — if you are a hospital inpatient, or in a post-anesthesia recovery room, or in an intensive care unit, you are there because you need access to a nurse. Health care as we know it today cannot exist without nurses. Further, nurse practitioners in their current role are a valuable part of the delivery of care, and I enjoy their input every day. However, converting our current advanced-practice registered nurses (i.e., nurse practitioners) to proto-physicians by allowing an expanded, unsupervised role in diagnosis and prescription is not the best solution to the problem Ms. McCoy describes.

We need enough funding for residency programs so that Texas medical graduates can stay here to train. We need loan repayment programs so that medical school graduates with six-figure education debts can get relief by practicing in rural areas (the 185 of 254 counties that Ms. McCoy mentions). We need to adequately pay for and respect nurses in their current role as members of the health care team. Anything else can compromise quality of care and patient safety.


Cynthia Malowitz said...

Outdated laws and an ongoing turf battle led by TMA seek to continue prohibiting nurse practitioners from serving as equal partners and to the full extent of education and certification. No one genuinely believes we have the capacity or resources necessary to educate and train enough physicians to cover our current shortfall, much less the addition of an ever-expanding population.

Peer-reviewed research throughout the past 4 decades, show that NPs provide low-cost and high-quality primary care whose patient outcomes and satisfaction is at least on par with and sometimes exceeding that of a physician. Physicians want to solve the problem with adding more costs to the taxpayers while nurse practitioners want to solve the problem by lowering costs. TMA says that our system must change. Again, you are absolutely correct. But, nothing will change if we continue to limit the abilities and effectiveness of all providers. It is time for the physician organizations to work with their APRN colleagues to create a better situation for our citizens.

Texans need care. Nurse practitioners are ready to provide it

Anonymous said...

There is NO MONEY to pay for more residency programs. There is NO MONEY to pay for loan repayment programs for medical school graduates. It makes economic sense to educate more NURSE PRACTITIONERS and convince them to stay in Texas by eliminating all these ridiculous restrictions.

Why is it the Institute of Medicine approves independence for nurse practitioners, but you, AN ORTHOPEDIST, does not? This is nothing more than a turf war and the people who are hurt the most are the patients.

Why is this the only profession that has to pay someone money in order to do what they're trained to do? Why are nurse practitioners being punished for opening clinics and caring for those in need?

How is it that NPs can go to New Mexico, Colorado, Arizona, Washington State, Washington DC, etc and practice COMPLETELY INDEPENDENT of physician oversight? We have MORE uninsured citizens in Texas than anywhere else in the U.S. It is time to end the turf war and do what's right for the citizens of this state!

Anonymous said...

We are not trying to be orthopaedic surgeons, this is primary care. I understand my scope of practice, and when to ask for help. Nurse practitioners and physician's can work together for the good of the patient. When this happens there is no compromise to patient care.

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Me And My Doctor Blogger said...

What ia your email address?

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