Health Care reform, whatever its shape going forward, will unquestionably require more primary care providers. But do they have to be doctors? Presently, primary care providers consist of Nurse Practitioners, Physician Assistants, and physician specialists in Family Care, Pediatrics, Internal Medicine, and Geriatrics.
According to the Agency for Healthcare Research and Quality (AHRQ) there were (in 2010) 55,625 Nurse Practitioners and 30,042 Physician Assistants involved in Primary Care for a total of 85,667 non-physician providers in Primary Care. In that same year there were, according to the AHRQ, 209,000 practicing Primary Care physicians.
Shouldn’t that be the other way around? I would argue that over 90% of primary care can be performed by a Nurse Practitioner. Do we really need a physician with 12 years of medical education and training to treat head colds and the like? Can’t we save them for more serious things like diagnosing and treating complicated diseases? Why can’t 1 physician handle the difficult cases referred by 5 Nurse Practitioners? Can’t we leverage the training and skill of physicians by employing more Nurse Practitioners to service the increased demand of health care reform?
I have been treated by many Nurse Practitioners over the years and have been very pleased with all of them. My wife’s primary care provider for many years was a Nurse Practitioner and she would have no one else. They are competent, compassionate and well suited to provide the vast majority of Primary Care. Nurse Practitioners are trained to treat the “whole” person and not just a medical “event”. In the long run, this is beneficial to the patient and may actually reduce the number of medical visits. Nurse Practitioners can prescribe medications in most states and have some degree of prescribing authority in all 50 states.
Then there is the issue of cost. One study found that the cost of providing primary care by Nurse Practitioners was 20% less than the same care provided by physicians. Add to this the fact that many physicians don’t want to practice primary care because of the reimbursement scenario. A physician can spend 20 minutes dealing with a family health problem and only be reimbursed for a 5 minute wart removal procedure.
We need more non-physician providers to leverage the training and skill of Primary Care physicians. Nurse Practitioners can provide independent primary care and Physician Assistants can help make the physician more productive. This should provide a cost effective way of dealing with the increased demand for health care predicted by health care reform.