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K.C. Arnold, nurse practitioner
Nurse practitioner K.C. Arnold spoke about proposed regulations at a recent meeting of the Mississippi State Board of Medical Licensure. Nurse practitioners have been increasingly vocal about their desire to practice independently, without physician oversight.
Photo credit: AP PHOTO

Stronger voice

Nurse practitioner groups seek bigger role in care

By Maureen McKinney
Posted: November 24, 2012 - 12:01 am ET

Consolidation has long been a topic of discussion among the leaders of the nation's two largest membership organizations for nurse practitioners. But with fast-approaching changes brought by the healthcare reform law and a growing demand for greater advocacy on behalf of the profession, 2012 proved to be the tipping point.

On Nov. 20, the American Academy of Nurse Practitioners and the American College of Nurse Practitioners announced they would merge, effective Jan. 1, 2013, forming a single 40,000-member organization known as the American Association of Nurse Practitioners.

“I think one of the key motivations was a stronger collective voice for the nurse practitioner community,” said Jill Olmstead, president of the American College of Nurse Practitioners. “Our goal is to advocate for the role and to provide better access for patients.”

The merger comes at a time when many nurse practitioners, who have master's degrees or doctorates in nursing, are pushing for greater freedom to practice independently in primary-care settings, citing looming physician shortages and the more than 30 million Americans who are soon expected to join the ranks of the newly insured. A number of states already allow nurse practitioners to practice without physician oversight.

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“Primary care needs to be where those people are entering the system,” said Angela Golden, president of the American Academy of Nurse Practitioners, “and we know that 70% of nurse practitioners identify themselves as primary-care practitioners. With 10,000 to 11,000 new graduates each year, plus the 158,000 we have already, nurse practitioners have a role in the new healthcare paradigm as patients' primary healthcare provider.”

That idea has met with plenty of push-back from physicians. In September, the American Academy of Family Physicians released a 26-page report, Primary Care for the 21st Century, which argued against putting nonphysician providers at the helm of primary-care practices.

In the report, the AAFP contrasted the education and training requirements for physicians with those of nurse practitioners and argued that allowing nurse practitioners to practice independently was the wrong way to respond to the physician shortage. Instead, the AAFP said, new models of team-based care would allow fewer physicians to run practices staffed with greater numbers of nurse practitioners and other clinicians.

“The nation can fill the primary-care gap through the continuing transition to team-based care in medical homes, with all health professionals playing valuable and appropriate roles. Studies show the ideal practice ratio of NPs to physicians is approximately 4-to-1,” the AAFP said in the report. With patient-centered medical homes “built around that ratio, everyone can have a primary-care doctor and receive the benefits of team-based care.”

Golden fired back in a September news release, calling the report's conclusions “misdirected.” She contended that nurse practitioner-led practices perform as well or better than physician-led offices on quality indicators and play a critical role in helping medically underserved populations.

Dr. Reid Blackwelder, AAFP's president-elect, responded to the news of the recent merger in an e-mail.

“We wish these two groups well in their reorganization,” Blackwelder said. “We look forward to working with them and other healthcare professionals to improve the quality of care for all patients.”

Blackwelder also reiterated the AAFP's stance that a physician-led care team is best for patients.

The leadership of the American Association of Nurse Practitioners will include top players from both of the merged organizations. David Hebert, who in January was named CEO of the American College of Nurse Practitioners, will be CEO of the newly formed association. Golden, who began a two-year term as president of the American Academy of Nurse Practitioners in June, will serve as president of the merged association until June 2013, when she will become co-president with American College of Nurse Practitioners President-elect Ken Miller.

And the group's new board of directors is set to meet in the second week of January to review strategic planning goals, Golden said.

“That will give us a chance to be clear about what we want to do going forward,” she said. “Health policy is at the top of that list.”

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