Reconsidering Scope of Practice: The Right Medicine for Primary Care?
November 15, 2013
The prospect of many newly insured Americans seeking care in 2014, along with an aging population and a growing chronic disease burden, have raised concerns about the adequacy of the nation's primary care infrastructure. One strategy put forward by the National Governors Association, among others, is to increase the supply of primary care services by expanding the role of nonphysician clinicians, such as nurse practitioners (NPs) and physician assistants (PAs). Both can be trained more quickly than physicians and have been shown to provide comparable quality of care; both are eager to use all their knowledge and skills. NPs in particular are more likely than physicians to choose primary care practice. About one-third of the states allow NPs to practice independently of physician supervision, but this remains controversial. Some see an answer in team-based care, with more patient care tasks being carried out by NPs and PAs. This evolution may be under way, but the optimal team composition and structure have yet to be determined. Geographic disparity remains a question, as many rural and underserved areas have trouble attracting providers at all. This Forum session considered the perspectives of physicians, NPs, and PAs on what research shows, what is happening in practice, and the outlook for primary care remodeling.
National Governors Association, "The Role of Nurse Practitioners in Meeting Increasing Demand for Primary Care" (December 20, 2012)