A new report issued by the American Academy of Family Physicians is causing some sparks in the medical community. Cautioning that the use of nurse practitioners in place of primary care physicians is just a ‘stop-gap’ measure, the report recommends the best method of transforming primary care is with physician-led medical teams.
"We are not trained to do the same things, so to imply that one can substitute for the other is just incorrect," says Roland Goertz, MD and chair of the AAFP Board of Directors. "The educational backgrounds are different. Even nursing leadership says 'we are not trying to be doctors,' but policy setters tend to simplify things, which is a kind way of saying it."
Needless to say, the nursing profession isn’t taking the findings in this report lightly. According to a senior fellow at the American Nurses Association, there is a basic agreement been the AAFP and the ANN that there needs to be a greater focus on primary care and preventative medicine. However, beyond that, there is a vast difference of opinion.
"I have mixed feelings when reports like this come out," tan ANA spokesperson says. "The bottom-line feeling at the ANA is that these turf battles that these kinds of reports turn into don't do a lot to benefit moving ahead the agenda of coordinating care, a shared goal of providing the best care for patients. That is our focus: How do we build truly integrated teams that keep the patient at the center of focus?"
She goes on to cite reports and recommendations from a wide range of sources, including think tanks and even AARP, that support the effectiveness of nurse practitioners and physicians assistants in delivering high quality health care. She points to “decades of evidence” that reinforce the value of, and the need for more, advanced practice nurses.
"What this report points out to me is that it is a continued effort by organized medicine to preserve the status quo by focusing on physicians," she says. "Folks are beginning to reject this antiquated notion that they only way to deliver high-quality, patient-focused care is to have this captain-of-the-ship model."
And no one disputes the need for more well-qualified nursing professionals. The high percentage of RNs reaching retirement age, changes in healthcare policy including a greater emphasis on preventative medicine, and an aging Baby Boomer generation who growing medical needs are just a few of the factors that underscore we are facing is a critical shortage of nurses in our healthcare system. There is an urgent need to recruit and train a whole new generation of nurses -- especially nurse practitioners.
As for this new report from the AAFP, the nurses aren’t buying into it. As their spokesperson says, "No intelligent healthcare professional practices 'independently' in the way they are suggesting in this report."
And even the AAFP’s Goetz concedes that this scope-of-practice debate is really between policy makers.
"If you are talking about on-the-ground activity where the teams are taking care of patients, there is not a lot of contentiousness about this, he says. “ Everybody understands the patient is the focus of attention. In the actual act of delivering care, I don't see a line-in-the-sand problem."
And for the good health of all of us, let’s hope he’s right!