David Blumenthal, M.D., Melinda K. Abrams
D. Blumenthal and M. K. Abrams, "Putting Aside Preconceptions—Time for Open Dialogue Among Primary Care Clinicians," New England Journal of Medicine, published online May 16, 2013.
In the coming years, demand for primary care in the United States is expected to swell, as millions of people gain insurance coverage under health reform and the population ages. Many experts expect a shortage of primary care physicians (PCPs). The U.S. has fewer PCPs per capita than in other wealthy countries: 30 per 100,000 people, compared with 80, 159, and 157, respectively, in the United Kingdom, France, and Germany.
An editorial by The Commonwealth Fund’s David Blumenthal and Melinda Abrams explores one approach to addressing the primary care workforce shortage: using nurse practitioners to provide a wide range of primary care services. According to research cited by the authors, nurse practitioners—also known as advanced practice nurses, or APNs—provide care comparable to that provided by primary care physicians, as measured by health outcomes, use of resources, and cost. In some respects, such as communication with patients seeking urgent care, they perform better than physicians.
However, the authors also note that PCPs and APNs receive different training and have different skill sets. Moreover, patients vary in their preferences regarding who provides their primary care. Blumenthal and Abrams recommend a flexible approach to crafting primary care workforce policy, one that is responsive to the changing roles of health care professionals and to changes in the organization and financing of health care. They also suggest that policymakers rely upon objective data on the competencies of professionals, rather than rigid state laws, to regulate providers’ roles, and that patients be given a voice in the debate.
"Unless physicians and nurses collaborate to improve primary care, neither will be happy with the outcome," the authors write. "We urgently need a facilitated, open dialogue about the roles of PCPs and APNs that includes representatives of the public."