Where does the Primary Care Nurse Practitioner Fit In?

With baby boomers and those with chronic health conditions burdening our nation’s current healthcare system and the primary care physician shortage worsening, many nurse practitioners are filling in the gaps.

Defined Role Vs Ability

As a result, a 2010 Institute of Medicine (IOM) committee made a sweeping recommendation that advanced practice registered nurses should be able to practice to the “full extent” that their training and education allows, which includes admitting patients to hospitals and hospices and leading medical teams. They also reported that they should receive similar reimbursements for providing the services that physicians receive for doing so.

However, a study by the New England Journal of Medicine disagreed with changing the scope of a nurse practitioner’s responsibilities. In particular, the study, which was led by Massachusetts General Hospital and the Institute for Medicine and Public Health at Vanderbilt University Medical Center, strongly disagreed with changing the leadership roles of nurse practitioners and their reimbursement levels.

The study came as quite a shock to many in the profession, as it was often thought these changes would come quite naturally, given the fact that primary care physicians and nurse practitioners have been working alongside one another for many decades. These differences in views may thwart the nation’s ability to redesign healthcare to improve the services provided.

Primary Care Physicians and Nurse Practitioners

Although the study looked into the roles of nurse practitioners and how expanding these roles may help a burdened healthcare system, there has been little data performed on the roles of nurse practitioners and how they may differ from the services provided by primary care physicians.

The study, which included a survey of 2,000 primary care providers, with 505 being physicians and 467 being nurse practitioners, found that the majority of respondents – 96 percent of nurse practitioners and 76 percent of primary care physicians – agreed that nurse practitioner should practice to the “full extent of their education and training.”  Seventy-six percent of nurse practitioners felt as if they were currently doing so.

However, other findings of the survey that showed the chasm that still exists between primary care physicians and nurse practitioners included:

  • 82 percent of nurse practitioners felt as if they should be able to lead medical teams, but just 17 percent of primary care physicians agreed.
  • 64 percent of nurse practitioners felt as if they should be paid equally for the same services, while just 4 percent of physicians agreed.
  • 60 percent of nurse practitioners felt as if they should provide services to complex patients with multiple conditions, while just 23 percent of physicians responded said these services were currently being performed by nurse practitioners in their practices.