Primary Care: How Much Is Too Much?

thermometerMore and more states are now allowing for nurse practitioners to work as primary care providers – without a doctor’s oversight. This is sending ripples through the medical world, as evidenced by this Op-Ed piece in the New York Times on the matter.

Of course, nurses are for the autonomy and doctors are firmly against it. In fact, this piece, written by a doctor, is scathing in its derision of nurse practitioners performing medicine.

To fully judge this situation, you need to consider both sides of the argument. Many reasons for nurse practitioners are very persuasive, but some doctors have a point, too.

As the health care landscape changes, the fight between doctors and nurse practitioners is only going to escalate. For nurses and patients, it helps to know the pros and cons to protect the safety of patients and bypass the politics.

The Case for Nurse Practitioners

Nurse practitioners are the newest providers in the health care schema. They are cheaper than doctors, more plentiful than doctors, and most of the time, as experienced as doctors.

For routine problems, nurse practitioners are more than capable of prescribing an antibiotic, referring someone to therapy, or sending the patient up the chain of command for more serious problems.

While it is true that nurse practitioners don’t have the same education as doctors, they often have real world experience with patients and illness that your average intern would kill for. Many of these providers have worked the floor for years and know what they are doing.

Primary care is essentially the domains of coughs and colds. Nurse practitioners are cheaper, easier to get into see, and competent in handling these common, everyday problems that take up the bulk of a doctor’s day.

The Case for Doctors

A case can certainly be made for doctors, and they do have a point. Doctors are specifically trained from the start of their career to diagnose and treat patients.

“Nurse practitioners when supervised can make health care cheaper and quicker for most routine patients.”

The background of a physician is usually much more in-depth than a nurse’s, and they operate through a different diagnostic paradigm. Doctors are experts in medicine, far more than a nurse, and they should be the ones to diagnose even small problems.

That isn’t even the argument made by most doctors, though. In many states now, the nurse practitioner isn’t required to have a physician overseeing his or her practice, and this is the main point of contention.

It is not that doctors disagree with nurse practitioners, and they can see the worth of these caregivers. What doctors strongly disagree with is the independent practicing of a provider that is not necessarily trained to diagnose and treat disease.

The Future of Primary Care

What most doctors fear is the two tiered system of primary care. They fear that some patients will go to unsupervised nurse practitioners to their detriment and that some would never set foot in a nurse practitioner’s office.

Neither is an acceptable alternative because both practitioners have their place in the modern primary care paradigm. Nurse practitioners when supervised can make health care cheaper and quicker for most routine patients.

However, doctors should not be so quick to dismiss a nurse practitioner operating independently. If the training is conducted in a way that makes their experience commensurate with a doctor’s, then why couldn’t they handle routine primary care problems without a physician’s oversight?

This argument is sure to continue well into the next decade as the cost of physicians increases and nurse practitioners seem like a cost effective solution. The question still remains about the safety of the patient when they see an unsupervised nurse practitioner, and whether those patients will be in danger from malpractice.

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