What will it take to end the turf war physicians are waging against nurse practitioners? The latest foray is over who should lead patient-centered medical homes (PCMH). According to the American Academy of Family Physicians (AAFP), only physicians should. They insist that nurse practitioners do not have the knowledge or skills to do so and that expanding the NP’s role in primary care would create a “two-tiered health system,” with patients who are cared for by an NP receiving a lower level of care.
That’s not what the evidence says. Or patients for that matter. Studies consistently find that when care provided by NPs is compared to care provided by physicians, the care is similar as far as prescriptions ordered and referrals made—most important, outcomes are the same.
Well, there is one area where differences keep showing up: patient satisfaction. Patients consistently say that they are more satisfied with care provided by nurse practitioners. They say that nurse practitioners listen better, spend more time with them, and provide them with more information.
Not only are nurse practitioners capable of leading medical homes, their education and skills make them ideal for this role. Whereas physicians focus on pathology and have the depth of knowledge and skill to manage highly complex patients, NPs focus on the “human response to disease” and take a more holistic approach to patient care. Nurses coordinate care all the time, identifying the need for and arranging home care, rehabilitative care, nutritional support, and so on. Combine this with an NP’s well-documented diagnostic and patient management skills, and their qualification for this role is obvious.
There already exists a two-tiered health system in this country—but not the one AAFP is imagining. It’s between those who have access to care and those who do not. Expanding the role of nurse practitioners in primary care is one of our best hopes for alleviating that. We know it, the Institute of Medicine (IOM) knows it, and patients know it. It’s time for physicians to accept it.