One answer to our health care crisis: Let nurse practitioners do primary care on their own
Wednesday, May 8, 2013
Posted by: Melissa Moody
April 18, 2013 (Slate) As of early April, you can walk into Walgreens in 18 states (plus D.C.),
and along with a gallon of skim milk, a pair of photo mugs, a six-pack
of toilet paper, and a flu shot, you can meet your new primary care
provider, get your cholesterol checked, pick up your statin, and
schedule a return visit. That primary care provider will not be a
physician but a nurse practitioner (or a physician assistant, but that’s
for another article).
Those states, and now Walgreens, have recognized
that nurse practitioners can handle a lot more than antibiotics for
urinary tract infections: They can practice primary care just fine
without physician oversight. And it’s a pretty smart move.
Lagging behind are the other 32 states (this map
lays it out), in which nurse practitioners are supervised to varying
degrees by physicians, the scope of their practice restricted by laws that vary from state to state.
In some states, nurse practitioners can’t enroll a patient in hospice,
order a wheelchair, or prescribe certain medicines without a doctor’s
signature. This is true even when it’s impractical geographically and
financially, not to mention belittling. Nurse practitioners in a number
of states, including Connecticut, Nevada, and West Virginia, are
currently pushing for legislation for the right to practice independently and improve access to care.
The time is ripe: Despite new medical schools
designed to attract students interested in primary care, the long
dwindle of interest in the field has left a gaping hole, and it’s
growing. When an additional 32 million or so Americans are covered
through the Affordable Care Act next year, the primary care physician
shortage could be catastrophic; it’s estimated to climb as high as
45,000 too few primary care physicians by 2020. Anyone who’s looked for a
new physician recently has probably heard some variant of this: "The
doctor isn’t taking new patients, but you can see the nurse practitioner
or the physician assistant.”