In the battle for primary care, both doctors and nurses are to blame

Apparently the Affordable Care Act has inspired panic among some physicians groups worthy of the fear historically reserved for deadly epidemics. From the articles I read, these groups are wringing their hands in hysteria over what to do and how to survive. One solution that has apparently gained popularity  in these circles is the  launching of campaigns against one of the most logical solutions, nurse practitioners.

Last fall, the medical association in my state purchased large blocks of advertising space to alert the public about the importance of knowing who’s treating you. They emphasized that “only physicians have the comprehensive diagnostic, pharmaceutical, and patient care background” (apparently) necessary to successfully treat the public for every malady from a hangnail to a heart attack. All this from within a state with some of the most dismal physician retention rates in the nation.

A simple Google search will enlighten anyone that we have enough people in need of health care to go around in this country. Yet, some physicians will argue that NPs do not possess the educational background nor the clinical experience to provide primary care to a portion of the soon to be 17 million newly insured Americans expected to flood waiting rooms come January one.

Access to care has become the new catch phrase and it has gained a momentum that threatens to roll downhill like the proverbial snowball headed toward a very hot place. The fears and suspicions directed toward NPs by certain insecure factions of the medical community does nothing to instill confidence in heath care in general and only serves  to insure an even more fearful and confused public.

Some campaigns touting  physician care as the only acceptable choice have simply backfired. Both lawmakers and the public at large are growing weary of those members of the medical profession who apparently want it all, and then, in the next breath wail that, with the ACA looming large on the horizon, they can’t possibly take care of it all. Such  logic would confuse Aristotle, cause Hippocrates to shake his head in disgust, and inspire Florence Nightingale to offer up a weary smile while Clara Barton would in all likelihood prefer to take another bullet through the shoulder of her dress than attempt to wring sense from this schizophrenic argument.

Advanced practice nursing  groups must also accept a portion of the blame for the battle. They lash back at every perceived slight by brandishing white papers, research studies, and reams of patient testimonials, thereby assuring a merry-go-round of futility that continues to spin out of control.

Now is not the time to cross swords. It behooves both professions to pause and think. Analysis of  any new process, such as the ACA, can be a prudent and productive step toward preparation, but the inspiration provided  by innuendos and rumor is an exercise in futility. I use the terms innuendo and rumor with regard to the ACA inspired hysteria. Because we do not know how reform is going to play out until it  actually begins to play. Roles cannot possibly be defined at this juncture. All involved badly need a superiority check.

Experienced NPs are capable of providing quality care for the majority of Americans. While entering this profession does not require a medical degree it does require an exceptional amount of fortitude and intelligence. I have heard that medical school is competitive, brutal, challenging, time consuming, and difficult. So is nursing school. Much has been made by some who represent the medical community about our lack of clinical residency hours compared to those of even a newly minted physician.

Yet, I know many NPs, like myself, who practiced as an RN for over two decades before returning to school to earn the graduate degrees that allow us the privilege to expand the parameters of our practice.

Yes, some NPs lack experience, so do some physicians. Some are better at what they do than others. The same is true of physicians. I have seen cases where patients have been  misdiagnosed by doctors and mismanaged by NPs. I have also seen shining examples of brilliance from the very best of each profession.

I like to joke that I did a thirty year “residency” before striking out on my own as an independent NP. I won’t even attempt to translate that into clinical hours , but I feel safe in assuming that most neurosurgeons have far fewer under their belts when they hang out their first shingle.

Apples and oranges? Some will say so. Still, if quality patient care is the big concern with regard to preparation for health care practice, then most NPs have  it. Few inexperienced NP graduates will seek independence right away. Most will work for physicians or under the tutelage of more experienced colleagues, allowing them to continue their educations. I spent my first twelve years as an NP working side by side with several physicians in a large multi-specialty practice before I even considered striking out on my own. I gained a wealth of knowledge during that time and I am grateful for the skills that were taught me  by those mentors.

It is time to work together as never before. Both our professions have much to give and  both possess the expertise to give it. No, the educations are not the same, but the goals are.

I respect physicians. I consult them when appropriate and they refer patients to me. I acknowledge their sacrifice of time, money, and self in pursuit of contributing to the greater good. I like to believe they respect me for those same sacrifices. I applaud those who support NP practice and acknowledge our profession as instrumental to the success of expanded care. I congratulate all those who put patient care above personal insecurities  and project genuine concern for patients.

I am a nurse. My practice comes from the very heart of nursing. I am not a doctor wannabe, but make no mistake, I am a doctor “could have been,” just as surely as I might  have been an astronaut or a Supreme Court justice had medicine, aerospace technology or law been my interest rather than nursing. My NP practice is something that evolved over thirty years of experience and it was the next logical step in my professional development.

I strive to provide  my patients with the best evidence based care while implementing  the nursing model as my guide. Often, I do this unconsciously, so ingrained  is this philosophy into my psyche. My thought process may differ from that of the medical model, but it will lead me to the same conclusions, plans of treatment, and patient outcomes.

As we await the coming storm that is the ACA, I believe both professions need to re-evaluate who we are and what we each have to contribute to improve heath care in America. Pulling together with mutual respect is a far better option than fracturing our talents into millions of useless pieces as we struggle to gain a foothold in this battle for primary care.

Kim Byars is a nurse practitioner and founder, Byars Family QuikCare.

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