When it comes to healthcare, the times are a-changin’. And while all of these recent changes in healthcare will likely affect you in both good
and bad ways, nurses aren’t the only ones who are dealing with these changes and what they mean for healthcare.
The New York Times recently published an article with an attention grabbing headline, “Nurses Are Not Doctors.” Written by Dr. Sandeep Jauhar, the story outlines his strong opinions on the New York Legislature bill passed in April that allows nurse practitioners to administer care without physician oversight, and how its outcomes affect doctors, nurses and patients.
Here are some key excerpts from the article:
- New York joins 16 other states and the District of Columbia in awarding such autonomy. (Most states still require nurse practitioners to work with physicians under a written practice agreement.) The bill’s authors contend that mandatory collaboration with a physician “no longer serves a clinical purpose” and reduces much-needed access to primary care.
- Last year the president of the American Association of Nurse Practitioners argued that the current diversity of health professionals rendered “hierarchical, physician-centric structures unnecessary.” As a physician, I couldn’t disagree more. Though well intentioned, such proposals underestimate the clinical importance of physicians’ expertise and overestimate the cost-effectiveness of nurse practitioners.
- Primary care pays the least of all the medical specialties, and interest in it is at a record low among medical students and residents. At the same time, as baby boomers are starting to retire and the Affordable Care Act adds millions to the rolls of the newly insured, the need for primary-care physicians is growing. Nurse practitioners have been promoted as a cost-effective way to meet this need.
- Medicare currently reimburses nurse practitioners only 85 percent of the amount that it reimburses primary-care physicians. Paying less for the same work would appear to be a way to save health care dollars.
- Nurse practitioners, though generally praised for being sensitive to patients’ psychological and social concerns, appear to order more diagnostic tests than do their physician counterparts. In one study, published in 1999 in the journal Effective Clinical Practice, primary-care patients assigned to nurse practitioners underwent more ultrasounds, CT scans and M.R.I. scans than did patients assigned to physicians. The nurse practitioners’ patients also had 25 percent more specialty visits and 41 percent more hospital admissions. These differences are costly.
- Medical school graduates, after two years of classroom instruction and two years of clinical training, are not considered fit to practice medicine independently. Yet in New York State next year, nurse practitioners with perhaps even less clinical education will be allowed to do so.
- Primary care, though often routine, is also about finding the extraordinary in what may appear to be routine. As a doctor recently wrote on Sermo, a physician online community, “It’s the ability to differentiate those pale shades of gray in patient care that counts.” To do so consistently, I believe, requires a doctor’s expertise.
- So if we want more primary-care providers, let’s have them be doctors. And to attract more of the best and brightest in our medical schools, let’s find a way to increase their pay. There is an essential place for nurse practitioners in medicine, but it is as part of a physician-led team. Nurse practitioners are worthy professionals and are absolutely essential to patient care. But they are not doctors.
Read the entire story here, then tell us, what do you think about the new bill? Do you agree with anything Dr. Jauhar wrote? What do you think the best way to move forward is? Tell us your thoughts in the comments below.