A role for nurses as supply of docs keeps shrinking
Insiders say team focus, not replacement, a worthy goal
At the same time physicians are being pressured to provide comprehensive primary care to a larger population, medical students here are continuing to leave the state after completing their education, primarily due to financial strains. That could create a larger role for nurse practitioners — specially licensed nurses with either master's or doctoral degrees — though insiders don't expect the primary-care physician to be replaced.
"I don't think a nurse practitioner is a substitute for a physician," said Dr. Alfred Tallia, chair of the Robert Wood Johnson Medical School family medicine department. "The training is very different. Having said that, I believe in the concept of practicing up to the maximum of your training," and nurse practitioners are extremely competent at many of the tenets of primary care.
Tallia said with health care heading into more of a team-based focus, the different competencies of various professionals will need to be combined in order for appropriate care to be delivered. This means nurse practitioners will be working with physicians, not replacing them.
Like physician assistants, nurse practitioners can perform many of the tasks associated with primary care, including exams and basic diagnosis, freeing physicians for more complicated cases. Some states allow nurse practitioners to open their own clinics in communities underserved by physicians; New Jersey is among the states with restrictions on the role practitioners can play within a primary-care practice.
Support for independent nurse practices comes from researchers who say NPs perform comparable to their physician counterparts in delivering effective care, as well as being reimbursed at 85 percent of what physicians are paid by Medicare.
Then, there's the matter of the numbers. New Jersey is expected to have a significant shortage of primary-care physicians in the next 10 to 15 years. It takes roughly 12 years of education and training for a primary-care physician to enter the field, while nurse practitioners need six years of education before being licensed.
Fairfield University, in Connecticut, recently was awarded a $700,000 grant to form the Unites States Health Resources and Services Administration, designed to fund 58 nurses to achieve practitioner status. No New Jersey institutions received funding through this grant program.
Dr. Meredith Kazer, associate dean of Fairfield's School of Nursing, said many of the students in the program want to start their own practices, which is easier to do in Connecticut than New Jersey.
Kazer said practitioners with doctorates have an understanding of leadership and system-wide focus, while practitioners with master's degrees have skill acting as the leader of an interprofessional team of caregivers.
"The sky's the limit," Kazer said.
But support for such expansion is not universal. The Princeton-based Robert Wood Johnson Foundation recently released a study on the field, stating despite comparable results, physicians are generally uncomfortable with expanding the independence of NPs over competitive, as well as safety, concerns.
For Dr. Robert Brenner, chief medical officer of the Summit Medical Group, acknowledging the changing role of a nurse practitioner means delegation and collaboration.
At Summit, "nurse practitioners are working collaboratively with physicians that they're embedded with," Brenner said. "More and more specialties have NPs working with them. For instance, in cardiology, we have nurse practitioners and physicians' assistants that work alongside the cardiologists."
Brenner said the cardiology practitioners do initial consultations, performing rounds on patients in the hospital and do some stress tests. It is unlikely Summit would increase nurse practitioner independence, Brenner said, but he doesn't rule it out for the future.
"When you put all of these disciplines together, you can wind up having a very powerful way of taking care of patients," Brenner said.
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