Few Doctors Say More Nurse Practitioners Would Improve Care
Although a majority of physicians agree that increasing the number of nurse practitioners would improve the timeliness of care, few believe doing so would improve safety and quality of care, according to a study published Wednesday in the New England Journal of Medicine, Kaiser Health News' "Capsules" reports.
The debate over expanding nurse practitioners' scope of practice has intensified in recent years as concerns grow about physician shortages when an estimated 25 million uninsured U.S. residents gain coverage under the Affordable Care Act.
For the study, researchers surveyed 505 primary care physicians and 467 nurse practitioners to gauge each group's opinions on the future role of nurse practitioners.
The study found that both groups agreed that nurse practitioners should be able to practice to the full extent of their education and training, but 25% of nurse practitioners said they are unable to do so because of state restrictions, hospital regulations and work settings.
While most members of each group agreed that increasing the number of nurse practitioners would increase the timeliness of care, they differed on the quality of care each group provides. Sixty-six percent of physicians said they provide a higher quality of care in exams and consultations compared with nurse practitioners, but 75% of surveyed nurses disagreed.
Physicians and nurse practitioners also differed on equal pay, with more than 64% of nurses reporting that they favor it, compared with less than 4% of physicians. Further, 82% of nurses said an advanced practice nurse could lead a medical home -- which delivers coordinated care to patients -- compared with 17% of physicians.
Physicians also are less likely than nurses to believe that expanding nurse practitioners' roles would increase safety or the effectiveness of care. Nearly 81% of nurses thought expanding their role would improve access to health care, and 77% said it would help reduce health care costs, compared with fewer than 33% of physicians.
Karen Donelan -- the study's lead author and an assistant professor of medicine at the Harvard School of Medicine -- said she was surprised by the level of disagreement over quality of care because previous research showed little variation in the care provided by both groups.
"As a team, this kind of inter-professional disagreement is not a good thing when we're trying to achieve better teamwork," she said, adding, "The conflict over roles has got to be worked out so that it's clear for patients when they get their care" (Tran, "Capsules," Kaiser Health News, 5/15).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.