NCPA - National Center for Policy Analysis

Why Nurses Need More Authority

May 11, 2012

The United States is facing a severe shortage of primary care physicians.  In addition to issues such as general population growth, especially among the elderly, is the problem of the Affordable Care Act (ACA).  Providing coverage to millions more Americans, demand for primary care is expected to increase sharply, further exacerbating the shortage of physicians, says John Rowe, a physician and a professor in the department of health policy and management at the Columbia University Mailman School of Public Health.

  • Should the ACA pass muster with the Supreme Court next month, an additional 30 million to 33 million previously uninsured Americans will be covered.
  • Even if the ACA is not implemented in full, and in the end merely expands Medicaid, it will add 17 million to the insured ranks by 2020.
  • The Association of American Medical Colleges predicts a shortfall of 29,800 primary care physicians by 2015 and 65,800 by 2025.

The health care industry already has the tools to adapt to this gradual change if it can muster the will. One of the best ways to alleviate this shortage is to expand the scope of practice for advanced practice registered nurses (APRNs), well-trained registered nurses with specialized qualifications who can make diagnoses, order tests and referrals, and write prescriptions.

  • APRNs could provide a variety of services that primary care physicians now provide.
  • The Institute of Medicine of the National Academy of Sciences conducted an exhaustive review of all the available studies of APRNs and concluded that properly trained APRNs can independently provide core primary care services as effectively as physicians.
  • Furthermore, the Rand Institute has argued in a recent report that unleashing the potential of nurses could yield significant savings for state-provided health care.

Despite the convenience of this solution, the medical sector remains resistant.  The American Medical Association, the American Osteopathic Association and the American Academy of Family Physicians all oppose expanding the scope of nurse-practitioner responsibilities.

  • Among the reasons provided, the physicians' organizations expressed concerns about lost income for doctors if their responsibilities are delegated away.
  • Furthermore, a general concern about the loss of the "captain of the ship" role for primary care physicians also exists.
  • Finally, the organizations argue that APRNs have less experience than actual physicians, ignoring the many responsibilities they could take on regardless of experience. 

Source: John W. Rowe, "Why Nurses Need More Authority," The Atlantic, May 7, 2012.

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