Nurse Practitioners, Docs at Odds

Board certified surgeons and pain interventionists aren’t the only ones having a scope of practice argument over who is best qualified to treat patients.

While some orthopedic surgeons assert that the government is limiting residency slots and could force medical school graduates into primary care, a study reported in the May 16, 2013 issue of the New England Journal of Medicine, showed that doctors don’t believe nurse practitioners provide the same quality of primary care.

Which raises the question of, if there is a need for more medical school graduates going into specialty residency slots, why would doctors not want nurse practitioners to take over some of the primary care burdens?

Quality of Care

Nearly 1, 000 doctors and nurse practitioners were surveyed in the study. Most were divided on the question of who gives the higher quality of care: Two-thirds of physicians said if a doctor and nurse practitioner provided the same service, the doctor would do it better. The nurse practitioners didn’t agree with that. Eighty-two percent of nurse practitioners felt they should lead their own practices, while only 17% of doctors did.

Nurse practitioners go through advanced education and training beyond the requirements to become a registered nurse. In about 16 states, they can do most of what doctors do—including heading their own primary care practices, prescribing drugs and performing medical procedures unsupervised. In other states, nurse practitioners may be required to work with a doctor.

Doctor Supervision

Some doctors’ groups, including the American Medical Association and American Academy of Family Physicians, have said that nurse practitioners should be able to practice only under the supervision of a doctor. According to the American Association of Nurse Practitioners, bills have recently been introduced in ten states to expand nurse practitioners’ scope of practice.

Safety and Effectiveness

According to the survey, the majority of practitioners in both groups agreed that increasing the number of nurse practitioners would improve timeliness of care. However, less than a third of doctors said such an increase would boost safety or effectiveness of care. Nurse practitioners, on the other hand, overwhelmingly felt such an increase would improve care. Close to 81% thought the growth would improve access to health care for the uninsured and 77% said it would result in lower health care costs.

Equal Pay

The doctors and nurses also disagreed about whether nurse practitioners should be paid equally for providing the same health services. More than 64% of nurse practitioners agreed with the idea of equal pay, as opposed to less than 4% of doctors. With an estimated 25 million people gaining insurance under the health care law, nurse practitioners argue they can fill some of those needs if they are granted greater scope of practice.

Karen Donelan, Ed.M., ScD, an assistant professor of medicine at the Harvard School of Medicine and the study’s lead author, reportedly said both sides need to “be at the table” in figuring out what primary care will look like in the future. “Achieving collaboration will take a lot of work, and it needs to be based on data rather than rhetoric.”