Physicians and nurse practitioners agree that NPs should practice “to the full extent of their license.” But the two groups strongly disagree on whether doctors
and nurse practitioners should receive equal pay for providing the same services and on whether NPs can lead a patient-centered medical home
practice, according to a survey published in the New England Journal of Medicine
Researchers from Boston-based Massachusetts General Hospital, Harvard Medical School and other institutions surveyed 505 physicians and 467 nurse practitioners in primary-care practice, and they found stark disagreements on their respective roles in fulfilling policy goals aimed at expanding access to primary-care services.
The authors noted how nurse practitioners play an important role in helping meet increasing demands for primary-care services, and they report that 70% of physicians and 90% of nurse practitioners agreed that NPs should practice to the full extent of their education and training. There was some common ground on what that meant, with the majority of doctors being OK with NPs conducting annual physicals, follow-up visits for controlled chronic conditions, patient and family instruction, and follow-up on abnormal test results. Most doctors objected to nurse practitioners conducting visits on uncontrolled co-existing chronic conditions and coordinating care transitions such as after a hospital discharge.
There were major disagreements elsewhere. Only 17.2% of physicians felt a practice led by a nurse practitioner should be certified as a medical home
, while 82.2% of NPs felt it should. Only 3.8% of physicians felt nurse practitioners should be paid equally for providing the same service, while 64.3% of NPs were in favor of this. And 66.1% of physicians surveyed said they agreed with a statement that doctors provided higher quality exams and consultations than nurse practitioners, while 75.3% of the NPs disagreed.
“Both physicians and nurse practitioners will be needed to address the many challenges of developing a workforce that is adequate to meet the need for primary-care services,” the authors concluded. “It is our hope that the stark contrasts in attitudes that this survey reveals will not further inflame the rhetoric that has been offered by some leaders of the two professions but rather will contribute to thoughtful solutions for healthcare workforce planning and policy.”
The study received financial support from the Gordon and Betty Moore Foundation, the Johnson & Johnson Campaign for Nursing's Future and the Robert Wood Johnson Foundation. The survey was conducted between Nov. 23, 2011, and April 9, 2012, and was sent to 957 randomly selected physicians and 957 nurse practitioners in primary-care practice.Follow Andis Robeznieks on Twitter: @MHARobeznieks