One of the most e-mailed NYTarticles/blog posts over the past twenty-four hours was Tina Rosenberg’s Opinionator/Fixes post “The Family Doctor, Minus the M.D.” (10-24-12). In her online article, Ms. Rosenberg focuses on the expanding role of nurse practitioners in providing cost-effective, accessible, comprehensive, and quality primary health care—especially in rural and underserved urban areas of the U.S. where physicians typically do not want to work. There is already a severe shortage of primary care physicians in the U.S., a shortage slated to grow with the ‘perfect storm’ of the aging/chronic disease-challenged population combined with Obamacare’s expanded coverage of previously uninsured patients.
Ms. Rosenberg, who is a journalist and contributing writer for the NYT Magazine (and not a nurse), points out that nurses “take a different approach to patient care than doctors(…)”—and that nurses’ more holistic approach to patient care is particularly useful in the management of chronic disease, especially in patients with complex socio-economic barriers to care. She included organized physician resistance to nurse practitioner-run clinics, citing a recent position statement by the American Academy of Family Physicians in which they oppose independent practice by nurse practitioners. Ms. Rosenberg points out that in sixteen states plus Washington, D.C, nurse practitioners have complete independence. (Of course, what she left out is the fact that nurse practitioners have to maintain their RN license; as RNs they are independent practitioners within commonly accepted nursing functions.)
It is a well-researched and well-written article. Perhaps equally interesting are the reader comments—all 295 of them. Unlike local newspapers, the NYT carefully moderates all reader comments. They screen them before allowing posting of only the “thoughtful, civil and articulate” ones. Most of the comments to this article were on-topic. There were the usual vitriolic negative comments by some physicians about care by nurse practitioners being “second rate care,” and how nurse practitioners were dangerous unless “under the direction of a fully trained and clinically seasoned M.D. or D.O.” There were the physician assistants weighing in with “what about me?!” and saying that since they were trained under the medical model they provided superior health care compared with nurse practitioners. There were patient testimonials (for and against) care they received by nurse practitioners. There was an off-topic comment about how all nurses are into narcotic diversion and are addicted (Nurse Jackie, you brought on this misconception). And there were more than a few comments about how professional “turf wars are only hurting the patients and the nation.” I agree with that sentiment. I also am glad to see a healthy debate about the need for more primary care providers in the U.S., as well as about the important role that nurses can (and do) play in our health care system.