The nurse is in: Nurse practitioners filling void in primary
care
KENNETT SQUARE, Pennsylvania (AP) -- Marguerite Harris and
her staff of eight provide prenatal care and child
immunizations, write prescriptions, and diagnose and treat
ailments from diabetes to the sniffles.
Though it may sound like a typical doctor's office, no one
on staff at Project Salud is a doctor. The medical center is
run by nurse practitioners -- registered nurses with
specialized training and advanced degrees -- whose numbers
in the United States have risen from 30,000 in 1990 to
115,000 today.
Increasingly, U.S. patients are being treated by nurse
practitioners. Nurse-managed primary care centers such as
Project Salud have increased to about 250 nationwide today,
from a small handful 15 years ago.
"We've come a long way since the early days, the knockdown
drag-outs with doctors who thought we were overstepping our
roles," said Harris, a nurse practitioner at the
Philadelphia-area medical center since 1974.
The change is attributed to factors that include a drop in
the number of doctors choosing primary care as their
specialty, a falloff expected to continue.
According to the American College of Physicians, U.S.
medical school surveys showed that from 1998 to 2005, the
percentage of third-year residents intending to pursue
careers in general internal medicine dropped from 54 percent
to 20 percent. Many new doctors, saddled with high student
loans, are choosing more lucrative specialties.
The supply of general practice physicians is falling just as
the American baby boomer population is aging and in greater
need of medical care, and nurse-run medical centers are
helping to bridge the gap.
Nurse practitioners first appeared about 40 years ago in
pediatrics, and quickly expanded into obstetrics and
gynecology, family medicine, and adult primary care.
They can perform many of the duties of primary care doctors
such as performing physical exams, diagnosing and treating
common health problems, prescribing medications, ordering
and interpreting X-rays, and providing family planning
services.
However, some physicians' groups are concerned about the
trend.
The American Medical Association is against giving full
autonomy to nurse practitioners, stating as its official
policy position that a physician should be supervising nurse
practitioners at all times and in all settings. An AMA
spokeswoman said the association would not provide
additional comment on its position.
"There is an element within the physician community that
gets a little antsy. ... They think it's going to take away
revenue and business from them," said Dr. Jan Towers,
director of health policy for the American Academy of Nurse
Practitioners. "Really, there's more than enough for
everybody."
A
2000 study in the Journal of the American Medical
Association concluded that patients who receive primary care
from nurse practitioners fare just as well as those treated
by doctors and report similar levels of satisfaction with
their care.
Nurse practitioners also have steadily been gaining greater
acceptance by insurers and in most states. In about half of
America's states, nurse practitioners -- who frequently have
lower fees for office visits than doctors -- are now
recognized by insurance carriers as primary care physicians.
"One of the statistics that stands out is that we (nurse
practitioners) see our patients twice as often as similar
practices of physicians," said Tine Hansen-Turton, executive
director of the National Nursing Centers Consortium, a
Philadelphia-based industry group. "Doing primary care well
is the foundation for saving health care dollars -- working
on improving health early instead of, for example, paying
for coronary surgery and bypasses later."
