Will nurses solve the primary care crisis?

by Derek Mazique

Between “death panels,” a NICE-style cost effective analysis board, and Obama’s slowly graying hair, one conspicuously absent part of reform are reimbursement rates. Medicare and private insurance typically reimburse for expensive procedures, which ultimately rewards procedure-heavy specialists while discourage those cognitive-heavy services like primary care docs.

The result? As a recent Baltimore Sun op-ed and this very blog pointed out, a combination of pay and burn-out are encouraging med students to pick specialties over primary care. While loan repayment and the US Public Health Service may stop the bleeding, Congress’ conciliatory moves away from true reform may be the death knell of primary care.

What’s primary care to do? Bring in the nurses. Namely, increase the recruitment of nurse practitioners who already perform many primary care duties. This includes increased reimbursement for hiring nursing educators and more funding for building nurse practitioner programs.

Unlike primary care, nursing schools turn away qualified applicants due the lack of teachers and facilities, something that increased cash from the federal government could help to fix. Such a ready and willing workforce could help fill the gap that many Americans find themselves in when looking for a primary health care provider.

The improvements that more NP’s would bring encompass more than just numbers. A recent report in Health Affairs by Kutney-Lee, et al. highlighted that patients’ reported higher satisfaction and would recommend a hospital to a friend if the nursing environment improved.

Nursing’s “patient-centered” model also allows for a personal primary care experience, and nurse practitioners have been proven to lower time on ventilators, complications, and length of stay. And on average, nurse practitioners earn $81,000 a year, almost half of the $160,000 that typical primary care docs (not including the cost of training).

Existing primary care docs could then phase into a supervisory role with a group of NP’s, and see the most complicated patients in a primary care setting before referring them to costly specialists. In this way, primary care docs would still retain their gatekeeper role.

Clearly this situation is not ideal – many primary care doctors want to and love to practice their craft, and shouldn’t be placed out by a reimbursement rule. If Congress doesn’t have the wherewithal to change retrograde reimbursement rates, though, at least federally mandated NP education would ensure that America’s patients don’t suffer.

Derek Mazique is a Clinical Research Coordinator at Johns Hopkins University.

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