Independent nurse practitioners are not the primary care solution

In her post, “The only thing that truly separates doctors from nurses,” Dr. Leng is right that our current system creates a great deal of confusion for patients. Clothing, titles and even the word “Doctor” are no longer clear enough for people to understand which member of the health care team is caring for them. However, her suggestion that ultimate responsibility for the patient is the only distinguishing feature is incorrect. The deeper differences must be recognized as state legislators consider granting independent practice to nurses, as 18 states have done already.  We have to think carefully about the implications of such changes for patients and the American health care system.

Saving money should not be the main factor for decisions that impact patient care and safety. Cutting costs by substituting nurses for physicians would lead the United States to two classes of care — one run by physicians and a second by differently qualified health care professionals. Some of our most needy citizens, such as those with little or no health care coverage, are most likely to lose their physician and be given a nurse. Every American deserves to have a personal physician and a nurse!

Contrary to Dr. Leng’s comment, the most important distinguishing aspects between physicians and nurses are indeed knowledge, skill and ability. Experienced non-physician providers are invaluable, but they can’t validate a variable educational process. Nurses are not physicians: nurse practitioners complete 5,350 hours of education and clinical training during five to seven years, varying from state to state, compared to primary care physicians 21,700 hours of education and clinical training during 11 years, that is standardized and consistent regardless of state or school. The additional training physicians receive brings extra breadth and depth to the diagnosis and treatment of all health problems, acute and chronic, as well as injuries, mental illness, health and prevention. A primary care physician is trained extensively to make the right diagnosis, even when symptoms are not clear. By contrast, nurse practitioner training focuses on ongoing treatment after diagnosis.

Yes, there is a primary care shortage that is expected to grow as the population ages and more Americans gain insurance coverage under the Affordable Care Act. But the answer cannot be to substitute care. We believe the answer is more physicians and more nurses working together in integrated, coordinated, physician-led health care teams through the patient-centered medical home. This model has proven to increase the quality of care for patients and improve cost-effectiveness for the health care system. Independent practice of nurse practitioners has not solved the primary care access issues or improved health outcomes at lower costs in those states that now have it. It is not the solution.

We value nurse practitioners. Family physicians work with nurse practitioners across the country. They are critical players on the health care team — but they are not physicians. A physician-led patient-centered medical home ensures we have the health care professionals we need and that every patient gets the right care from the right medical professional at the right time.

Reid Blackwelder is president-elect, American Academy of Family Physicians.

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