Expanding the primary care supply

There really isn’t much need for further comment on the idea of enabling nurse practitioners and other non-physicians to practice at the top of their training and to help meet the demand for primary care. It was the lead subject in yesterday’s Wonkbook. So, you could go read that. Just over a week ago Mike Miesen reported on the fate of California’s nurse practitioner scope of practice legislation for Project Millennial, where he has covered the issue before (and before that). So, you could go read that too.

Suffice it to say, this is a well-worn idea, but a good one. Even if one believes that physicians would provide higher quality or safer care (and one must ignore some evidence to hold these views), primary care physicians are in short supply in some regions. Health reform will accelerate the strain on that supply.

In light of these facts, for what reasonable, patient-centered reason should other health care professionals not practice at the top of their education and step into the breech? Is the argument that it would be better to see no health care professional or wait a long time to do so than to see a nurse practitioner for primary care? It hardly seems reasonable.

In any case, Victor Fuchs agrees. In a new JAMA viewpoint, he wrote,

The demand for primary care is strong and likely to grow stronger. It is, however, unwise to think that the demand could or should be met by an increase in the supply of primary care physicians. […] With proper organization, the majority of first-contact primary care could be met by an increase in the supply of nurse practitioners, physician assistants, and medical aides working under a “leader of a primary care team” who has been specially trained for such a role. Moreover, the leader’s compensation could and should be comparable with that of other specialists. Such leaders could, where appropriate, subspecialize into pediatric, adult, and geriatric care.

How is this not a good idea? At the very least, why is it not worth trying in regions that are in clear need of more primary care? I acknowledge that some physicians may view this as an encroachment of their turf, unwanted competition. Nevertheless, for the good of patients, and the country, docs need to get out — or be pushed out — of the way on this one.


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