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Nurse Practitioners to Put Primary Care Physicians on the Unemployment Line?

By Steve Simmons, MD

In order to solve the increasing shortage of primary care doctors many experts have proposed a plan to fill the void with nurse practitioners (NPs).  This acknowledges the necessary role primary care plays in our health care system while ignoring the actual qualifications for the job.  Furthermore, by failing to address why doctors are leaving primary care these experts unwittingly will ensnare us further in the same trap we currently find ourselves in today.  Independent of whether or not nurse practitioners are qualified to practice medicine without a supervising doctor is the following fact: they are avoiding primary care medicine for the same reasons as doctors.

As we determine who will take the lead on providing primary care, we should consider what is best for our patients.  Nurse practitioners fill an invaluable role by taking on many of the day-to-day problems and there is little doubt that our patients benefit from their skill and experience.  Anyone suggesting that nurse practitioners can replace physicians should understand that the nurse practitioners’ training program teaches them to provide care within the structure of a healthcare team led by a supervising doctor.

What can doctors provide their patients that nurse practitioners cannot? Depth of knowledge. Seven years of study in medical school and residency provide a doctor with the depth to understand complex medical conditions more difficult than the average day-to-day medical problem.  With experience, many nurse practitioners can provide excellent care for patients suffering a difficult or unusual problem; yet without that experience this lack of depth can be the difference between a good and bad outcome.

A very good nurse practitioner I work with once said, “I am only as good as the doctor backing me up, when I am working with a good doctor, I’m great.”   This helps exemplify how nurse practitioners can rely on physician supervision to help prevent unnecessary tests, procedures, and misdiagnoses.

When a patient needs the care of a specialist, a nurse practitioner might find it difficult to advocate for the patient without the necessary parity of experience with the specialist.  In my training, it was unthinkable to give absolute control of a patient to a specialist. Specialists need to focus often leaves them unable to best serve the overall interests of the patient.  While no primary care doctor can perform a highly technical procedure on their patient, they can advise as to whether the procedure is necessary or not.  Every patient needs someone to coordinate their care plan while keeping in mind his overall best interests.  An unsupervised nurse practitioner may find it intimidating to tell the enthusiastic specialist “no” while advocating for what is best overall for the patient.

The idea that you can replace a doctor with a nurse practitioner does not address the underlying problems that will continue to drive all healthcare providers away from primary care medicine.  I hope that anyone suggesting a solution for the shortage of primary care doctors tries to understand why the shortage has occurred in the first place. Then and only then will there be enough primary care providers to care for us all.

Until next time, I remain yours in primary care,

Steve Simmons, MD

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