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Doctors Reluctant to Expand Nurse Practitioners' Role: Survey

By Amy Norton
HealthDay Reporter

WEDNESDAY, May 15 (HealthDay News) -- The United States has a shortage of primary care doctors, and some policymakers want to fill the gap by expanding the role of nurse practitioners. But the two professions are engaged in a turf war over who can do the job better, a new survey finds.

The results of the survey were reported in the May 16 issue of the New England Journal of Medicine.

Experts expected some controversy, but said they were surprised at how far apart doctors and nurse practitioners were in their opinions.

The nearly 1,000 doctors and nurse practitioners surveyed were most 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.

Perhaps predictably, few nurse practitioners agreed with that. And although 82 percent of nurse practitioners felt nurse practitioners should lead their own practices, only 17 percent of doctors did.

"We weren't surprised that there were differences in their opinions, but we were surprised by the magnitude of the difference," said lead researcher Karen Donelan, a senior scientist at the Mongan Institute for Health Policy at Massachusetts General Hospital, in Boston.

Dr. David Blumenthal, co-author of an editorial published with the study, agreed.

"It's striking how different their perceptions are, even though they work in the same physical environment," said Blumenthal, president of the Commonwealth Fund, a New York-based foundation that supports research on health policy.

So what does all of that mean? Blumenthal and Donelan said the divide between doctors and nurse practitioners has implications for how U.S. health care looks in the future.

Based on a number of studies, Americans' demand for primary care providers is straining the limited supply. The Association of American Medical Colleges estimates that by 2015 the United States will face a shortage of more than 33,000 primary care practitioners.

A Commonwealth Fund survey found that 16 percent of U.S. adults have to wait at least six days for a doctor's appointment when they have a health problem that needs attention. And experts expect the shortage to worsen with health care reform, which will extend insurance coverage to about 30 million more Americans.

Some policymakers think nurse practitioners offer a way to address the problem.

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.

On paper, it makes sense to expand the role of nurse practitioners in primary care because their education and training is shorter -- an average of six years versus 11 or 12 years for doctors, including residency training. By some estimates, anywhere from three to 12 nurse practitioners can be educated for the price of producing one doctor.

Donelan said there also is evidence that nurse practitioners do just as well as doctors when it comes to primary care -- and that patients needing urgent care actually give nurse practitioners better marks on communication.

But what is not known, she said, is how well nurse practitioners measure up against doctors when things get more complicated, such as in cases in which a patient's diagnosis is unclear or a patient has multiple chronic health conditions.

In those cases, Blumenthal said, "there's no literature as to the superiority of one profession over the other."

If nurse practitioners are to gain an expanded role in primary care, laws in many states will have to change, Blumenthal said.

In 2010, the Institute of Medicine, an independent panel that advises the federal government, issued a report saying that many states' regulations on nurse practitioners were "overly restrictive" and based on politics.

The two professions' national societies see the issue differently. 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.

But the trend seems to be going against those groups. According to the American Association of Nurse Practitioners, bills have recently been introduced in 10 states to expand nurse practitioners' scope of practice.

Donelan 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," she said.

More information

The University of Pennsylvania has information on nurse practitioners and health care reform.

SOURCES: Karen Donelan, Sc.D., senior scientist, Mongan Institute for Health Policy, Massachusetts General Hospital, Boston; David Blumenthal, M.D., president, Commonwealth Fund, New York City; May 16, 2013 New England Journal of Medicine

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