What is the problem?
Since the onset of Covid-19, there has been a shortage of primary care physicians nationally. Keeping consumers healthy is extremely important and that means maintaining primary care. Over the years, studies have shown that maintaining primary care reduces costs and increases the overall quality for its consumers. Nurse practitioners can play an important role in expanding primary care capacity.
Nurse practitioners (NPs), are advanced practice registered nurses (APRNs) who are prepared at the master’s or doctoral level to provide primary, acute, chronic, and specialty care to patients of all ages and walks of life. Daily practices include: assessment, ordering, performing, supervising, and interpreting diagnostic and laboratory tests, making diagnoses, initiating and managing treatment, including prescribing medication and nonpharmacologic treatments, coordinating care, counseling, and educating patients, their families, and their communities. NPs are able to provide aspects of primary care similar to those of physicians and need fewer years of training than physicians making them more immediate support to a stretched primary care workforce.
NPs are important for areas of the country that face severe primary care physician shortages – this shortage is particularly acute for rural areas and Southern states where the patient-to-primary care physician ratio is higher and where fewer physicians are choosing to practice. Studies show that NPs are more likely to practice in these underserved areas than primary care physicians, increasing access for Medicaid patients, and the uninsured.
One of the major issues lies within each state’s scope-of-practice. In the United States, the practice of medicine, including who may practice and under what condition, is generally regulated by individual states. State scope-of-practice guidelines define the exact care functions Nurse practitioners are allowed to perform—such as diagnosing, treating, and referring patients, as well as, prescribing medications for them — and the conditions under which they are allowed to perform them. For instance, Alaska allows NPs to diagnose and prescribe all medications without physician oversight, while Missouri requires written documentation of physician involvement.
States are responsible for ensuring, through licensure and certification, that healthcare professionals provide services that commensurate with their training. Each state can support consumer access to health care by passing legislation that eases restrictions on NP scope-of-practice. By expanding the NPs autonomy and scope-of-practice, primary care itself is strengthened. Not only do NPs free up physicians to handle more complex patient cases, but they also reduce costs because their average earnings are half those of physicians. The bottom line is, by expanding NPs scope-of-practice and removing barriers, primary care capacity itself is increased.
Several studies have attempted to measure differences in the quality of care offered by NPs and physicians. Among the quality of care components that these studies measure are several process measures, among them patient satisfaction, time spent with patients, prescribing accuracy, and the provision of preventive education. In each of these categories, NPs provided at least equal quality of care to patients as compared to physicians. When it comes to patient satisfaction, studies show that NPs were found to have equal or higher patient satisfaction rates than physicians and tended to spend more time with patients during clinical visits. These studies showed that NPs generally prescribe medications well and follow clinical care guidelines and show no differences in the prescribing quality between NPs and physicians.
During the Covid-19 pandemic, one of the push-backs states are dealing with, in regard to expanding scope-of-practice laws for NPs, is potential opposition from the physician community. Many physician groups are opposed to expanding NP scope-of-practice expressing concerns about the overuse of specialty services and overall quality of patient care. Claims that NPs increase patient use of services through over-referral to specialists are unsubstantiated and studies show that the quality of patient care by NPs is comparable to the quality of patient care by physicians.
What is the solution?
In order to conquer the shortage of healthcare providers during the Covid-19 pandemic, the best choice is utilizing all our resources. NPs are essential to meeting our goals and assisting in helping all parties involved. If NPs are performing the same services as physicians, it goes without saying that they deserve equal reimbursement for services rendered. There must be a wider discussion about how the health care delivery system transforms to meet the needs of patients; this will involve more team care and shared responsibility.
- Patientengagementhit.com – “Making the Case for Expanded Nurse Practitioner Scope of Practice.”
- BMJ.com – “Randomized controlled trial comparing cost-effectiveness of general practitioners and nurse practitioners in primary care.”
- Kff.org – “Improving Access to Adult Primary Care in Medicaid: Exploring the Potential Role of Nurse Practitioners and Physician Assistants.”
- Chcf.org – “California’s Nurse Practitioners: How Scope of Practice Laws Impact Care.”
- Pubmed.gov – “Outcomes associated with advanced nursing practice prescriptive authority.”