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Editorial: I'm a Nurse, But Call Me Doctor!
Within the next few years we will have another 32 million Americans accessing our healthcare system. Who will be their healthcare providers? This is an especially big problem given the aging Baby Boomer population, the improved longevity of all Americans (infants to older adults) with acute as well as chronic diseases, and the projected shortage of primary care doctors (see Figure 1).
In response to the shortage of primary care providers, 28 states are now seriously considering expanding the role and responsibilities of nurse practitioners. However, are nurse practitioners as good as primary care physicians in providing care? Are their patient outcomes the same or better? All nurse practitioners hold advanced degrees, have concentrated clinical training, and are required to have extensive clinical experience before they can practice. But are they as good as primary care doctors at diagnosing and treating patients? And, are patient satisfaction scores just as high or higher?
Multiple randomized studies show that no differences are found in patient outcomes when patients are treated by either a doctor or a nurse practitioner, nor are there higher levels of health services utilization when doctors and nurse practitioners had the same authority, responsibilities, and administrative requirements (Kinnersley et al., 2000; Mundinger, Lenz, Hopkins, & Lin, 2000; Venning, Durie, Roland, Roberts, & Leese, 2000). Some studies even suggest that nurses are better at listening to patients, usually spend more time with patients, are better at educating their patients about their illnesses, have higher compliance rates to treatment, and are just as competent in making referrals to specialists when needed (Hopkins, Lenz, Pontes, & Mundinger, 2005; Horrocks, Anderson, & Salisbury, 2002; Kinnersley et al.). In addition, the care nurses provide costs less than primary care physicians’. These studies further demonstrate that nurses receive higher patient satisfaction scores compared to physicians.
Within the current healthcare environment, these “Dr. Nurses” are essential to fulfilling the multiple and complex long- and short-term care needs of all patients, especially those most vulnerable and underserved (e.g., veterans, frail children and adults, persons who are poor or homeless, those most at risk for falls or developing pressure ulcers, minority groups). As might be expected, the American Medical Association (AMA) is opposed to nurse practitioners treating patients without doctor supervision and objects to nurses being called “doctor” even though nurse practitioners may have doctorates in nursing practice or PhDs (Johnson, 2010).
The evidence strongly supports that nurse practitioners and other types of advanced practice nurses are clearly capable of providing high-quality primary care at a lower cost (Coddington & Sands, 2008). The powerful lobby of the AMA should not determine whether nurses should be allowed to practice independently (e.g., ambulatory care, wellness centers, long-term care, home-based primary care, school-based health centers, nurse-managed clinics). This should be a consumer-driven, evidence-based decision-making process centering on the documented quality of interventions, patient outcomes, and patient satisfaction scores.
Association of American Medical Colleges. (2008). The complexities of physician supply and demand: Projections through 2025—Center for Workforce Studies. Washington, DC: Author.
Coddington, J. A., & Sands, L. P. (2008). Cost of health care and quality of patients at nurse-managed clinics. Nursing Economics, 26(2), 75–84.
Hopkins, S. C., Lenz, E. R., Pontes, N. M., & Mundinger, M. O. (2005). Context of care or providing training: The impact on preventive screening practices. Preventive Medicine, 40(6), 718–724.
Horrocks, S., Anderson, E., & Salisbury, C. (2002). Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. British Medical Journal, 324(7341), 819–823.
Johnson, C. (2010, April 13). With doctor shortage, 'Dr. Nurses' seek bigger role in primary care. Retrieved April 30, 2010, from www.startribune.com/lifestyle/health/90760849.html.
Kinnersley, P., Anderson, E., Parry, K., Archard, L., Turton, P., Stainthorpe, A., et al. (2000). Randomized controlled trial of nurse practitioner versus general practitioner care for patients requesting “same day” consultations to primary care. British Medical Journal, 320(7241), 1045–1048.
Mundiger, M., Lenz, E. R., Hopkins, S., & Lin, S. (2001). Comparing NP and MD primary care outcomes: Two-year follow-up. Abstract Academy for Health Services Research and Health Policy Meeting, 18, 181.
Venning, P., Durie, A., Roland, M., Roberts, C., & Leese, B. (2000). Randomized controlled trial comparing the cost effectiveness of general practitioners and nurse practitioner in primary care. British Medical Journal, 320(7241), 1048–1053.