Survey Identifies Professional Divide Regarding Nurses’ Role in Primary Care

Most physicians agree that nurses should practice to full extent of their education and training.

    • June 11, 2013

More than three-quarters of physicians (76%) agree with the Institute of Medicine report recommendation that “nurse practitioners should be able to practice to the full extent of their education and training,” according to a study published in the New England Journal of Medicine (NEJM). But the study finds significant disagreement between nurse practitioners (NPs) and physicians on the quality of care provided by NPs, and how to expand their role in primary care.

Perspectives of Physicians and Nurse Practitioners on Primary Care Practice” finds that 73 percent of physicians say increasing the supply of primary care NPs would lead to improvements in the timeliness of care, and 52 percent say it would lead to improvements in access to care for people in the country. More than 80 percent of NPs said the growth of their profession would improve access to care.

But despite considerable evidence that the care provided by NPs is comparable to that provided by physicians, the survey found that physicians did not believe increasing the supply of NPs would improve patient safety and the effectiveness of care, or reduce costs.

Seventy-five percent of nurses disagree that physicians provide higher quality care than NPs in exams and consultations, and 77 percent of NPs said the growth of their profession would result in lower health care costs.

The survey also found a large professional divide about proposed changes to NPs’ scope of practice—such as leading medical homes or providing care for complex patients with multiple conditions—and putting NPs in leadership roles.

These findings are consistent with the results of a Robert Wood Johnson Foundation (RWJF) study conducted within the online Sermo.com community, Interim Pioneer Team Director Lori Melichar Gadkari, PhD, MA, wrote on the RWJF Human Capital Blog. Physicians in that survey agreed that allowing advanced practice registered nurses (APRNs) to practice independently would increase access to primary care in the U.S., but predicted a decrease in average quality of care provided if all states allowed APRNs to practice independently. “These predictions are not evidence based,” Melichar Gadkari writes.

“The differing views of physicians and nurse practitioners about their work can have troubling consequences,” David Blumenthal, MD, MPP, and Melinda K. Abrams, MS, write in an editorial accompanying the NEJM study. “That problem is the predicted shortage of primary care clinicians as the U.S. population ages and as millions gain insurance in 2014… One option in addressing the threatened primary care shortage is to rely on nurse practitioners to provide a wide range of primary care services… The existing literature shows that nurse practitioners provide care similar to that of physicians with respect to health outcomes, resource utilization, and cost, and the same studies show that nurse practitioners get higher grades than physicians with respect to communication with patients seeking urgent care.”

“We urgently need a facilitated, open dialogue about the roles of physicians and nurse practitioners that includes representatives of the public,” Blumenthal and Abrams conclude.

The NEJM survey of 972 clinicians (505 physicians and 467 nurse practitioners) was co-funded by RWJF, Johnson & Johnson, and the Gordon and Betty Moore Foundation. It is authored by Karen Donelan, ScD, EdM, Catherine M. DesRoches, DrPH, Robert S. Dittus, MD, MPH, and Peter Buerhaus, PhD, RN.

Read the study.
Read the blog post by Melichar Gadkari.

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