I had been thinking about writing an article on workforce issues but two events yesterday (Nov. 14) pushed the issue. An article was published in the Hospice and Palliative Medicine Smartbrief announcing that the American Enterprise Institute (AEI) has endorsed independent practice for NP’s in primary care. AEI is a high-profile conservative think-tank and public policy organization with an impressive list of scholars (former US Senators, global activists, political commentators, business leaders and the current President of the Counsel for Economic Advisors). AEI is influential with political commentators, policy and law makers.
Currently about half of US states permit full scope independent practice for NP’s. The AAFP’s published policy is that NP’s should practice only under collaboration with a physician.
AEI listed several compelling arguments supporting their decision:
· NP workforce is growing faster than family medicines’ – this is obvious, they are much “easier” to train requiring much fewer resources and time.
· NP’s are more likely to work in rural and underserved areas – I wonder if this will change over time. Do they work in rural areas because they are more accepted there by rural states allowing more independence? Would this change if more urban states allow full independence?
· The most controversial recommendation is that the report states they provide more cost-effective care than primary care docs!
The comments in this position statement were interesting to read. Predictably, it broke down to the physician/medical student faction versus the NP/PA one. Also, as expected, the comments became personal and unsavory at times.
On the same day I first saw a commercial on MSNBC produced by the American Association of Nurse Practitioners promoting the profession. This is similar to what the AAFP did a few years ago promoting the profession with its own commercials. It’s obvious the AANP has launched a new initiative to promote the profession directly to the public.
In a recent national business magazine, the CEO of Froedtert (Milwaukee) stated that patients don’t need a personal relationship with a primary care physician. Having recently worked for Froedtert and knowing their difficulty in recruiting enough primary care docs (not unique to Froedtert) it was not surprising to me that they are now promoting NP’s and PA’s as a primary care choice in an economic model to staff their expanding network.
Our primary care physician workforce is increasingly under significant challenge. I want to be clear that most of us want to work with NP’s/AP’s, but in a collaborative relationship. More and more this is being legislatively lost. In addition, the reality is that extended providers are cheaper and easier to get. It’s plausible to see that a NP/PA economic model would be favored by insurance companies and now health care systems. Health systems are in an expansive mode. They need workers. What is our response? Wisconsin has been a leader in expanding our workforce in smaller cities (new medical college campuses in Wausau and Green Bay with a focus on primary care). But, it’s not nearly enough to meet the exploding provider demand. I’m concerned that the economic and political winds will blow by us on this issue. We need more medical students to choose family medicine and more family medicine residency slots. But we have been pushing this for years with an insufficient response. Importantly, we need more research to show whether our years of extra training really result in better patient outcomes. Unfortunately, all of these forces are moving much too slowly for what is happening in the healthcare marketplace.
Wisconsin is currently a state which requires MD or DO/NP collaboration. But, with the landscape rapidly changing, I suspect multiple forces will eventually try to get this to end as has happened in many other states. To meet our nations needs we need many more family docs and we needed them yesterday!
I am always curious in hearing your thoughts. I can be reached at firstname.lastname@example.org. Thank you for being a member of OUR academy.