Nurse practitioners are assuming a more prominent role in primary care. Maryland is the latest state to allow this group to practice independently, and the Veterans Health Administration may soon follow suit.
The drivers for this trend are clear: the expansion of health insurance in the U.S. and our aging population, both producing heavy demand for primary-care services; shortages of primary-care physicians in many parts of the country, especially in rural areas; an urgency to lower care costs in the system; and pharmacy chains and big-box retail stores looking to use primary-care medicine (staffed primarily by nurse practitioners) as a “loss leader,” in part to build brand loyalty for their health-related products and services.
We could benefit from knowing more about nurse practitioners. Scattered studies in the primary-care sphere show that, in some cases, nurse practitioners perform on a par with their physician counterparts. These findings tend to focus on lower-level acute and chronic-disease care, which is traditionally the primary-care work to which NPs have been consigned. We also have sporadic studies that show patient satisfaction and care utilization among NPs comparing favorably with primary-care physicians. But at present the overall body of research lacks integration and examines a limited scope of primary-care medicine.
Ardent supporters of using NPs may feel that enough evidence already exists to justify independent NP practice in all types of primary-care medicine, not just the simpler variety. Spurred on by conditions in the primary-care environment that are driving greater NP practice freedoms, they may believe it is better to push ahead and let the research catch up later. This is a mistake. Similarly, those who assert that NPs cannot fully replace primary-care physicians must understand that the absence of a large, integrated body of data proving otherwise does not justify their conclusions either. Thinking it does is another mistake.
The future viability of primary-care physicians depends on synergizing their own strengths with a growing workforce segment—nurse practitioners—that thinks and acts a lot like them. Otherwise, disruptive innovations like retail clinics and urgent-care centers will act unilaterally and erode their market share and influence.