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The Primary Care Shortage: What We Can Do Today

The new healthcare reform law, which is called the Patient Protection and Affordable Care Act (PPACA), will be a huge disappointment to the millions of previously-uninsured people who finally purchase insurance policies when they try to find a doctor.

Primary care physicians are already in short supply and the most popular ones have closed practices or long waits for new patients. Imagine when 2014 hits and all of those patients come calling. Who is going to be available to treat them? Read more »

*This blog post was originally published at EverythingHealth*

Is A Nurse Practitioner A “Doctor?”

Nurse practitioners are demanding a wider scope of practice and even to be called “doctor” if they have a doctorate. And 28 states are considering giving them what they want, to which physician societies object.

Health policy analyst Jack Needleman (a Ph.D., so he gets to be called doctor, too), says the quality of care is the same. (He’s also an honorary fellow of the American Academy of Nursing.) AMA president-elect and internist Cecil B. Wilson, M.D., a Master of the American College of Physicians, (who is definitely called doctor) says the primary care shortage is a call for more physicians, not for fewer. Read more »

*This blog post was originally published at ACP Internist*

Nursing Bloggers Dish About The State Of Their Profession

I was following an interesting conversation on Twitter between several nurses. They were expressing concern about how nursing stereotypes were damaging to their profession. I invited them to discuss the subject with me via podcast.I have summarized some key points below.

You can listen to the whole conversation here.

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Gina from Code Blog (6 year veteran blogger, and has spent 11 years as an ICU nurse)

Strong One from My Strong Medicine (an anonymous blogger, athletic trainer and nurse of 3 years)

Terri Polick from Nurse Ratched’s Place (has held various positions in nursing, including psychiatric nursing for 20 years)

Current Nursing Challenges:

1. Nursing Instructor Shortage – nursing instructors make about 25% of the salary of nurses who do clinical work. Therefore, there are long wait times to enter nursing school due to instructor shortages. Many students can’t afford to wait, and choose other careers.

2. Inequality of Respect – some nurses feel that they have to continually prove themselves despite their training and qualifications. Patients often express disappointment or annoyance when they see a nurse practitioner (rather than a physician) in a group practice. Some doctors still expect nurses to give up their chairs when they enter the room.

3. Nursing Stereotypes – the “naughty nurse” and “nurse Ratched” images are still very much in the forefront of peoples minds when they think of nursing as a specialty. Some people believe that nurses simply pass out pills and make coffee, when in reality they are active in complex technical procedures and saving lives. These stereotypes and misconceptions denigrate the education and technical expertise of nurses.

4. Primary Care Doesn’t Pay: nurse practitioners incur higher debt and have lower salaries than specialist nurses. Just as in the medical profession, there are no incentives for nurses to choose careers in primary care.

Strengths of Nursing:

1. Nurses Are Better And Brighter Than Ever – since getting into nursing school is so competitive, the quality of individuals who are entering nursing school has never been higher.

2. Job Flexibility – nurses can easily transition to part time work for maternity purposes. Nursing careers offer a wide variety of work experiences – from nursing home work, to cardiothoracic surgery. One license offers hundreds of various opportunities.

3. Job Satisfaction – saving lives and serving patients contribute to a sense of job satisfaction.

What can be done to improve and advance the US nursing profession?

1. Establish an Office of the National Nurse. The National Nursing Network organization is promoting this initiative. The National Nurse would act as a government spokesperson for nurses-  promoting preventive medicine, increasing awareness of nursing, and securing financial support for nurse education. He or she would be the chief nurse officer of the US public health service.

2. Do not be afraid to speak up. Nurses should feel comfortable defending their professional ideals, and discouraging stereotypes.

3. Blog to raise awareness of nursing challenges and successes.

**Listen to the podcast**

Nurses May Not Fill The Primary Care Shortage: “We’re Not Suckers”

There is a critical shortage of primary care providers in the United States. The public’s perception is that there is no shortage, and politicians have spent very little time talking about how to address the shortage. The American Academy of Family Physicians has been carefully studying this issue and strongly recommends incentives for physicians who would consider primary care: increased reimbursement for non-procedural work, and medical school debt-forgiveness are two of many.

The universal coverage system in Massachusetts immediately unmasked the problem of the primary care shortage. Newly insured citizens have been astonished to discover that they cannot find a primary care physician even though they want one. Wait times often exceed 6 months, and very few physicians are accepting new patients.

I have had the privilege of listening in to various healthcare reform discussions among politicians and advocacy groups here in Washington. Every time I raise the issue of “what will you do about the primary care shortage?” they offer the same tepid response: all providers will need to “work together” to provide primary care services, and innovative programs like retail clinics and nurse-driven care models will help to fill the gap in physicians.

My friend and fellow blogger, Dr. Rich Fogoros recently wrote an amusing (and cynical) post about how physicians should simply “hand over” primary care to nurses. (The same argument that many politicians seem to be making). The only problem with this reasoning is that nurses may not be willing to provide primary care services for the same reasons that physicians aren’t too keen on it: the pay is low, the workload is grueling, and there are other career options that offer better lifestyle and salary benefits.

I spoke with a group of nurses on a recent podcast about this very issue and their view was that, “we’re not suckers” – primary care is not as appealing as ICU work, for example.

Gina (Code Blog): Not every nurse wants to go back to school for additional years and shell out a lot of money to become a nurse practitioner and then not make a whole lot more than we’re making now. I’ve worked with nurse practitioners who have come back to work in the ICU because they can’t make enough money in primary care to support their families.

Strong One (MyStrongMedicine): We don’t have enough educators to teach nursing at our nursing schools. Nurse educators are paid about a quarter of what they’d make at the bedside. There are long waits to get into nursing school because we don’t have enough instructors to handle the influx. Until that problem is solved we aren’t going to see in increase in nurses entering the market.

Terri Polick (Nurse Ratched’s Place): I have a friend who’s a nurse practitioner and she had to borrow over $100,000 for her education. I’m a three-year diploma nurse so technically I don’t even have a college degree – but I’m making a lot more than nurse practitioners and I don’t have all that debt. Politicians need to know that nurse practitioners can’t just “pick up the slack” from physicians. Nursing and medicine are two different specialties and we’re trained to do different things.

So for those of you out there who may have shrugged at the primary care shortage and figured that when the docs are gone, someone else will just pick up the slack – think again. Any national universal coverage system will simply unmask what many physicians have known all along: equal access to nothing is nothing. Without making primary care a more attractive career option for providers of all stripes, don’t expect an influx of any sort into the field.

Long wait times for basic healthcare will probably become the norm in America.

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