Guest Commentary: Where are Nurse Practitioners in Health Care Reform?

Theresa Pluth Yeo, PhD, MPH, MSN, CRNP, AOCNP
Coordinator, Advanced Practice Oncology Nursing Program
Assistant Professor, Jefferson Schools of Nursing and Population Health
(Former President of the Nurse Practitioner Association of Maryland)

Cortese and Korsmo, in their September 23, 2009 article in the NEJM, observed that, “Americans do not consistently receive high-value health care. Collectively, our country spends more on health care than any other nation, but our people do not receive the best outcomes, safety, service, or access (to health care) in return.”

Our health care system is largely dominated by a plethora of specialists but deficient in primary care physicians. At a time when only 247 residency positions in primary care are available for graduating medical students per year (down 328 residency positions since 1999), over 6,000 nurse practitioners (NPs) are educated each year at more than 325 colleges and universities. Most of these NPs choose primary care or family practice settings for employment. (For the uninitiated, NPs are fully-trained and licensed registered nurses who complete a Master’s or doctoral degree as an advanced practice nurse and pass a certifying examination administered by a national board, which allows them to be licensed by state boards of nursing as a NP).

NP educational programs provide training in the diagnosis and treatment of acute minor illnesses, disease prevention, and management of stable chronic conditions. Nurse practitioners are part of the solution in health care reform and fill an important niche in providing access to a qualified health care provider for millions of Americans. NPs are a win-win for patients – NPs bring their education, compassion and experience as RNs to bear on patient care, yet they are paid less than physicians. An ever growing body of evidence points to comparable quality care – and often higher patient satisfaction – with NPs as primary health care providers. Currently there are 139,000 NPs practicing in the US.

So why is the AMA threatened by NPs? In October 2009 the AMA launched an offensive, targeting NP practice in a document entitled: AMA Scope of Practice Data Series – Nurse practitioners. The document states in part that: “The physician is responsible for the supervision of nurse practitioners and other advanced practice nurses in all settings and that the physician is responsible for managing the health care of patients in all practice settings.” This is blatantly untrue. Nursing has been a self-regulating and self-licensing profession for as long as medicine has. Why has the leadership of the AMA decided that physicians and only physicians have the “right” to assess, diagnose and treat ill persons and that all “non-physician providers” should be supervised by a physician?

The American Nurses’ Association recently issued a response to this AMA document, voicing its objection to the AMA’s attempts to change the public’s perception of NP practice as anything other than fully qualified professionals working within a legally established scope of practice. As America struggles to reconstruct its health care delivery “system,” it is unproductive for one profession to attempt to marginalize another. NPs stand ready to help meet the nation’s health care needs as collaborating partners, not as physician supervised providers. Health care reformers look our way!