Roles Of Physicians And NPs In Improving Access To Care: Internists Issue Policy Paper

Main Category: Primary Care / General Practice
Also Included In: Nursing / Midwifery
Article Date: 18 Feb 2009 - 0:00 PDT

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"The American College of Physicians (ACP) has always recognized the unique role that a personal physician plays in meeting the needs of individual patients," Jeffrey P. Harris, MD, FACP, president of the American College of Physicians, noted upon the release of a new policy monograph. "But even the most committed physician can't do it alone. ACP shares its ideas on how nurse practitioners and physicians can work together - as teammates that respect and recognize each profession's unique contributions and skills - to provide patients with the best possible care."

By covering seven positions, Nurse Practitioners in Primary Care updates and clarifies ACP stands in areas that include:

• Coverage of physician and NP training, knowledge, skills and abilities
  
  
• Coordinated care to of primary importance in improving health outcomes
  
  
• Licensing and certification exams
  
  
• Multidisciplinary care in the patient-centered medical home model
  
  
• Research efforts for patient management among physicians and NPs
  
  
• Education and training of all health professionals
  
  
• Workforce policies to improve patient access to quality care

The 18-page monograph's executive summary notes that "anticipated and actual shortages of primary care physicians have led policymakers to consider the roles of nurse practitioners (NPs) in improving access to primary health care services. "Physicians and nurse practitioners not only share a commitment to providing high quality care, the paper says, but also face similar challenges regarding reimbursement and workforce outlook. Recognizing and building on the common ground between the two professions is vital to improving collaboration to meet the complex health care needs of the population.

However, the paper also cautions "that advanced practice nursing should not substitute for, or replace, primary care medical practice as provided by general internists, family physicians and other physicians."

"The ACP hopes that this paper will strengthen the dialogue between the medical and nurse practitioner communities to improve future health care delivery," said Dr. Harris. "A high-quality and efficient health care system requires effective multidisciplinary teams that collaborate to provide patient-centered care."

Over the past 20 years, the ACP paper notes, an increase in the numbers of nurse practitioners, enactment of state laws expanding scope of practice, prescriptive authority and third-party reimbursement, and national efforts to improve health care access, have resulted in expanded roles for NPs in providing primary care services. However, greater autonomy of NPs has been a point of contention between the medical and advanced practice nursing communities. At times, questions have been raised about the adequacy of NP training and certification, comparisons drawn by NPs to the care delivered by physicians, quality of patient outcomes and perceived intentions to displace or replace primary care physicians.

ACP's paper cited a study by the Association of American Medical Colleges that warns that the demand in the coming years for primary care physicians will outpace supply faster for primary care than for any other specialty group. It notes that another study published in Health Affairs projects a growing shortage of primary care physicians for adults, even as the contributions of nurse practitioners, as essential members of the primary care workforce, are taken into account.

In the process of developing its recommendations, ACP consulted with highly-regarded members of the nursing profession to gain a better understanding of their perspectives.

ACP intends to continue its dialogue with nurse practitioners, and to similarly engage in discussions with other professions - particularly physicians assistants - who play a vital role in meeting the nation's growing need for primary care.

"The key to high performance in multi-disciplinary teams is an understanding of the distinctive roles, skills, and values of all team members," Dr. Harris concluded. "Our hope is that ACP's new paper will help contribute to a better understanding of how physicians and nurse practitioners can work together to provide patients with the best care possible."

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The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 126,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection and treatment of illness in adults.

Source: David Kinsman
American College of Physicians

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