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Erie Family Health Center


Nursing Our Way Out

May 27, 2010 | Ginny

We’ve heard the chants of “Yes, we can!” We watched health care reform pass through the House of Representatives and the Senate. Above all, we’ve had a magic number tattooed in our minds since the first whisper of health care reform came out of Washington. 32 million. 32 million people that, once the health care reform package comes to fruition in 2014, would be able to enter into a physician’s office without financial fear.

The idea of just handing out health insurance to those in need of it seems wonderful. Unfortunately, it isn’t that simple. In a way, it’s like giving everyone in Chicago a free CTA pass for one day. You may have the means to ride the El, but if the train is full, you’re not going anywhere. The same idea goes for health care. In April, Dr. Francis blogged on Beats Per Minute about the shortage of primary care doctors available to care for this surge of now-insured patients and how community health centers could be the new training ground for upcoming generations of primary care doctors. Also back in April, Health Beats blogged about the upcoming physician shortage, as well as the possibility of reducing some of the restrictions on nurse practitioners to help lessen the blow of incoming health care demand surge.

Nursing Our Way Out

Twenty-eight states are taking the same route in addressing the shortage of primary care physicians. These states, which include Illinois, are considering loosening the regulations and restrictions of nurse practitioners (NPs) and expanding the types of services that NPs can provide. The Patient Protection and Affordable Care Act, which was recently signed into law by President Obama, will bring nursing midwives to the same Medicare pay rate as OB-GYNs. This new health care law will also give $50 million to nurse-managed health clinics that offer primary care to low-income patients, $50 million for hospitals to train advanced degree nurses to care for Medicare patients as well as 10% bonuses for medical providers, including NPs, who work in areas where physicians are limited.

Recently, the National Nurse Act of 2010 has been introduced into the House. This Act would create a “National Nurse” who would be nominated by the Secretary of Health and Human Services and would be equal in standing with the Deputy Surgeon General. Regardless of whether or not this Act makes it all the way through Congress, it is still another piece of evidence that nurses are continuing to make head way in health care.

The Other Side

Currently, laws vary widely across all states on what NPs can and cannot do. Many states place doctors in charge of NPs, while Montana doesn’t require doctor collaboration with NPs in any way. Also, some states bar the use of the ‘Dr.’ abbreviation for nurses who hold Doctorates of Nursing while a majority of other states allow it.

The Macy Foundation, a New York-based non-partisan charity that focuses on the education of health professionals, recently called for NPs to be amongst the leaders in primary health care and urged the removal of state and federal barriers that keep NPs from being able to provide primary care. While acknowledging the need for additional health care providers, the American Medical Association (AMA), however, but does not see increasing the roles of NPs as a solution to the physician shortage. “A shortage of one type of professional is not a reason to change the standards of medical care,” said Dr. Cecil Wilson, the AMA president. “We need to train more physicians.”

Whatever the solution, the health care world does recognize the need for exponential growth of primary care providers over the coming years. Getting everyone a ticket to health care is only half the battle – getting them through the exam room doors is what’s going to be the tricky part.

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