Blog | Friday, May 17, 2013

QD: News Every Day--Doctors, nurse practitioners work together as they fight over scope of practice


Physicians and nurse practitioners may frequently work together, but they don't get along when it comes to scope of practice issues. The long-simmering feud now has some data meant to fuel discussion rather than inflame rhetoric, study authors concluded.

Researchers conducted mailed survey of 505 physicians and 467 nurse practitioners in primary care from November 2011 to April 2012, (response rate, 61.2%) asking about scope of work, practice characteristics, and attitudes about expanding the role of nurse practitioners. Results appeared in the May 16 issue of the New England Journal of Medicine

In describing their clinical practices, physicians reported working longer hours, seeing more patients, and earning higher incomes than nurse practitioners. A total of 80.9% of nurse practitioners reported working in a practice with a physician, compared to 41.4% of physicians who reported working with a nurse practitioner.

Further highlighting the gap in proper scope of practice, nurse practitioners were more likely than physicians to believe that they should lead medical homes(17.2% of physicians vs. 82.2% of nurse practitioners) or should be paid equally for providing the same services (3.8% of physicians vs. 64.3% of nurse practitioners).

When asked whether they agreed that physicians provide a higher-quality examination and consultation than do nurse practitioners, 66.1% of physicians agreed and 75.3% of nurse practitioners disagreed. Another difference: 88.9% of physicians in collaborative practice agreed that "nurse practitioners typically defer certain types of patient care services and procedures to the primary care physician," compared to 61.3% of nurse practitioners (P less than 0.001).

Researchers noted that primary care physicians are unlikely to embrace expanding the role of nurse practitioners for fears of health care quality. This stems in part because "nurse practitioners and physicians come from very different cultures of professional education, are guided by different theoretical perspectives, and often develop their clinical skills in different practice environments."

Authors wrote, "Both physicians and nurse practitioners will be needed to address the many challenges of developing a workforce that is adequate to meet the need for primary care services. It is our hope that the stark contrasts in attitudes that this survey reveals will not further inflame the rhetoric that has been offered by some leaders of the two professions but rather will contribute to thoughtful solutions for health care workforce planning and policy."

In an editorial, David Blumenthal, MD, FACP, president of The Commonwealth Fund, wrote that the feuding comes amid an increasing primary care shortage. Nurse practitioner provider the same quality of care with better scores on patient communication, yet complex-disease care remains unanswered and patient preferences about who provides care need to be considered.

Dr. Blumenthal highlighted four points to consider in future policy talks:
--Objectively interpreted data on the differing competencies of these two types of clinicians should guide policy, "not rigid, often antiquated state laws";
--Policy should be flexible as studies increase understanding of physicians and nurse practitioners' roles;
--Patients should have a larger say in who provides their care; and
--There must be higher priority given to developing the primary care workforce.

He wrote, "[U]nless physicians and nurse practitioners collaborate to improve primary care, neither will be happy with the outcome. We urgently need a facilitated, open dialogue about the roles of physicians and nurse practitioners that includes representatives of the public."