NPs, PAs, and MDs, Oh My!

The individual mandate in the Affordable Care Act requires nearly all individuals to purchase health insurance. Subsequently, the issue of adequate provider supply comes into question. This is because it is believed that when more individuals have health insurance it is more likely that we will see more individuals using health care services. This is especially true at the primary care point of service. But, there is a problem, our health care system has been short staffed at the primary care provider position for several years. So the question arises, what can our health care system do to handle the increase of individuals seeking care?

Health Care ProvidersAs I have written in the past, several retail pharmacies including CVS have seen this gap and have stepped in to provide several of the services furnished by a primary care doctor. To provide this care, these pharmacies are using Nurse Practitioners at the point of service provider rather than hiring primary care doctors. The inclusion of Nurse Practitioners – and Physician Assistants – in primary care services has long been debated. With the changes in today’s health care system, it is time for this debate to come back to the forefront.

First, it is important to look into the benefits and draw backs of using Nurse Practitioners and Physician Assistants as the point of service individuals. Nurse Practitioners and Physician Assistants can perform many of the same procedures that doctors can. The primary difference between the two is cost. The salaries of Nurse Practitioners and Physician Assistants is incredibly lower than those salaries of physicians, causing the services they provide to cost much less. This is how places like CVS can provide several normally expensive services for under $100. Additionally, using more Nurse Practitioners and Physician Assistants could help extend care to both rural and poorer areas where very few physicians want to practice.

The potential drawbacks in using Nurse Practitioners and Physician Assistants are few, but important to discuss. First, most states require that a Nurse Practitioner must work directly with a licensed physician. This relationship is generally used for more complex cases and, in some instances, approval of prescribed medicines. The second drawback in the use of Nurse Practitioners and Physician Assistants is the existence of the perception that they do not provide the safest and most efficient care. These issues have been at the center of many policy debates in several different states.

One of these states debating the expansion of Nurse Practitioner provided care is Nebraska. The bill, proposed by Senator Sue Crawford, aimed to remove several of the restrictions placed on Nurse Practitioners in the state. The goal of the proposed legislation was to provide Nurse Practitioners with more freedom in the provision of care outside of formal Nurse Practitioner and physician relationships. The bill passed the unicameral legislature unanimously (43-0) and was then vetoed by the governor on the last day of the session, leaving no time for an override. The reasoning behind this veto was that the governor and his officials had concern for patient safety, to which Senator Crawford cited several studies that confirmed nurses provide safe and effective care. With the governor leaving office in January due to term limits, Senator Crawford has committed to reintroducing the bill during the next legislative term.

It is clear that something needs to be done to increase the number of primary care providers in our healthcare system. To combat this issue, more states need to have discussions like the one Nebraska has been having. This is because the benefits that Nurse Practitioners and Physician Assistants bring to the healthcare system greatly outweigh their short comings. Additionally, many of these short comings are overstated. As mentioned, the belief that these providers do not provide the safest and most efficient care is largely unfounded, and there have been many studies released that prove the opposite. Individuals who choose to become Nurse Practitioners and Physician Assistants receive quality education which, in many ways, rivals the education primary care physicians receive. The abilities that Nurse Practitioners and Physician Assistants bring to the table cannot be ignored and it will be incredibly important for states to continue to expand their responsibilities to help deal with the increased volume of patient visits.

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