The American Academy of Family Physicians published an inflammatory report last month mocking the nurse practitioner profession. Citing a lack of education and competence, the AAFP is taking a stand against nurse practitioner’s ability to practice independently upholding the physician as the sole professional capable of adequately caring for patients. Is this a sign of a primary care turf war breaking out?
News of healthcare reform and an impending shortage of primary care providers has been great press for NP’s. The media is calling on nurse practitioners as the natural solution to fill the gap of primary care providers created by more Americans becoming insured along with a decrease in interest in the primary care field among physicians. This has not gone unnoticed by physician organizations. Usually against NP’s practicing independently but still cordial, the AFFP has recently broken their tradition of tolerance and is stepping out strongly against NP’s. Referring to nurse practitioners as “less qualified” and implying that more NP’s in independent practice would “downgrade [medical] care”, the AAFP leaves little rom for nurse practitioners in their healthcare model.
No Room for NP’s With the AAFP
The healthcare community is under pressure to decrease the cost of medical care in the U.S. As costs of healthcare continue to skyrocket, Americans are crying for a solution. The AAFP believes the solution to this problem is an idea known as the patient-centered medical home (PCMH). PCMH is essentially a team of physicians, specialists and generalists managing all aspects of a patient’s healthcare together. The AAFP warns that if nurse practitioners are allowed to participate in this model, it will create two classes of healthcare: one run by a physician team the other “by less qualified health professionals”. The AAFP report states that “Substitution of nonphysician health care providers for physicians is not the solution, especially at a time when primary care practices are being called upon to take on more complex care.”
The AAFP can’t have it both ways. They are taking about the creation of healthcare teams involving numerous specialists in one breath and then stating that primary care providers need to “do it all” in the next. With the ever increasing involvement of specialists in patient care, NP’s are even more qualified to practice independently. If the AAFP is advocating collaborative care with specialists, NP’s will be more readily able to refer complex patients to receive specialized care as needed. Furthermore, why can’t nurse practitioners serve as the ‘generalist’ in the AAFP’s PCMH model. If healthcare is moving towards a team-based approach for patient management, nurse practitioners deserve a spot in the line-up. Not on the bench.
AAFP’s Flawed View of the Nurse Practitioner Position
According to the AAFP, “The family physician is trained to provide a complex differential diagnosis, develop a treatment plan that addresses multiple organ systems, and order and interpret tests within the context of the patient’s overall health condition. Nurse practitioners on the other hand, are specifically trained to follow through on the treatment of a patient after diagnosis and to implement protocols for chronic disease management.”
The AAFP’s definition of a nurse practitioner is extremely flawed. How can this organization determine the nurse practitioner role in healthcare if they mistakenly believe nurse practitioners are only “trained to follow through on the treatment of a patient after diagnosis and to implement protocols for chronic disease management”. Working in the ER as a nurse practitioner, I do an awful lot of diagnosing on a daily basis- in fact, the ER model is based more on diagnosis and less on following through with disease management. Trust me, I do not need an MD behind my name to diagnose otitis media, strep throat, diabetes or hyperlipidemia. Nurse practitioners are perfectly capable of performing all stages of the medical model from diagnosis to treatment and management.
It is no secret that nurse practitioners attend many years less schooling than physicians, also cited by the AAFP as a reason NP’s should not practice independently. Clinical experience, however has the power to eventually overcome this educational deficit. Nurse practitioners with at least a few years of clinical experience working as a nurse practitioner are perfectly capable of practicing independently in primary care. NP’s, like physicians, must be responsible for referring to a specialist when they feel a patient’s medical condition is beyond their capabilities. Overall, experienced nurse practitioners have the skills and medical knowledge necessary to practice on their own.
The AAFP needs a reality check. Their view of nurse practitioner’s capabilities is flawed. Physician organizations must realize that nurse practitioners are valuable members of the medical community. No, we don’t think we are doctors or that we have undergone the same amount of medical training. Yes, we do think however that we are capable of independently providing primary care after gaining experience.