September 20, 2012
(The New York Times News Service) -- With a shortage of primary care providers looming, the idea of using nurses and physician assistants to fill the gap often appears to be gaining traction. But according to a report released this week by the American Academy of Family Physicians, having more nurse practitioner-led medical practices is not a viable solution.
"Perceived shortages don't justify less than qualified care for our family," said Dr. LaDona Schmidt during a conference call about the report. She was a nurse practitioner before receiving her medical degree in family medicine.
Instead, the organization urges the adoption of physician-led, patient-centered medical homes, a model of care that promotes integrative care to help lower health care costs. The model is supposed to decrease referrals to specialists and help doctors diagnose and treat patients with the collaboration of their staff and administration.
The tension between some nurse practitioners and physicians has become more palpable in recent years as these nurses with advanced degrees have received more authority in some states to diagnose, treat and prescribe medicine. In 16 states, they can practice independently of a physician. Physician assistants receive different training and work under the direction of doctors, but some have also advocated for them to have more independence from physicians.
In physician-led, patient-centered medical homes, nurse practitioners work under the supervision of doctors, often managing pain and long-term treatment. AAFP members said this model cuts down on readmission rates and increases patient satisfaction.
Citing a difference in education, the report's authors said nurse practitioners receive 5,350 hours of training and study on average, compared to the 21,700 hours that physicians accumulate through medical school and residency. Nurses can practice at the end of their studies, which include clinical training, while doctors go on to their internship and residency, a difference that the report said is crucial to treating a patient.
Describing her experience in both roles, Schmidt said medical school provided a depth to her understanding of the human body that wasn't clear as a nurse. The report said that while nurse practitioners are vital to performing procedures and long-term care treatment, the complexities of the human body are better handled by a physician.
Research on the health care outcomes of nurse practitioners suggests two sides to the pro-physician argument. A study published in the Journal of the American Medical Associated (JAMA), for example, found that there were no significant differences in patients' health status when they were treated by nurse practitioners instead of physicians for primary, ongoing or urgent care.
But THE AAFP board chair, Dr. Roland Goertz, said that recognizing the strength of both health care providers and integrating them into patient-centered medical homes was the only way to address a shortage that hits rural areas especially hard.
"I think we're beyond testing it," said Goertz about the medical home model. "I think the evidence is there supporting it in a very large way."
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