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Physicians Continue to Battle NPs over Expanded Role

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The nationwide battle over the expanded role of nurse practitioners continues to play out on both the grassroots and legislative levels. To anyone who has studied this issue at length, the results of a recent New England Journal of Medicine study won’t surprise you: doctors and NPs really disagree on this topic.

According to Alvin Tran at Kaiser Health News, “The study found the two groups overwhelmingly agreed that nurse practitioners should be able to practice to the full extent of their schooling and training. But doctors were less likely to concur that advanced-practice nurses should lead medical homes, which deliver team-based, coordinated care to patients.”

In fact, out of the 505 primary-care physicians included in the survey, only 17 percent endorsed an NP’s expanded role. Only four percent of the physicians thought that NPs “should be paid equally for providing the same health services.” Sixty-six percent of the physicians felt the care they provide is of higher quality than that which NPs provide (75 percent of NPs disagreed with this assertion).

Ironically, the two groups actually agreed that more NPs would improve the “timeliness of care.”

Dr. Karen Donelan, lead author of the study and an assistant professor of medicine at the Harvard School of Medicine, marveled at the gap between physicians and NPs.

She said, “We’ve done a lot of comparative surveys with health professionals, but we’ve just never found gaps this big. When we get on the ground and we survey the people actually doing the work and working together, we see some of those professionals come closer together. We didn’t observe that here.”

The reason this issue is even being debated, Tran notes, is because of the physician-shortage crisis, “as an estimated 25 million people gain insurance under the healthcare law. Nurse practitioners argue they can fill some of those needs if they are granted greater scope of practice.”

David Herbert, CEO of the American Association of Nurse Practitioners, recently said physicians are using their safety concerns about the quality of NP care as a “total red herring,” especially since “nurse practitioners have been practicing safely and providing great outcomes for decades.”

“As a team, this kind of inter-professional disagreement is not a good thing when we’re trying to achieve better teamwork,” Donelan said. “The conflict over roles has got to be worked out so that it’s clear for patients when they get their care.”

For the physicians reading this blog, how do you feel about expanding the role of nurse practitioners? When seeking employment, how important is the NP’s role within a group or an organization in your decision to accept that job? Finally, what do you think it would take to bridge the gap between physicians and NPs?

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