The World According to Physicians and Nurse Practitioners

There is concern about the adequacy of primary care provider supply, particularly in light of the impending expansion of coverage, and there is concern about controlling health spending.  One approach to addressing each is to expand the number and role of alternative primary care providers, like nurse practitioners and physician assistants.  Physicians, however, have typically zealously guarded their turf.  A survey of 505 doctors and 467 nurse practitioners reported in the New England Journal of Medicine reveals a wide gulf in the groups view of their value and place in the system.  (NEJM Article)    Nurse practitioners are significantly more likely to be female and white than doctors and they have a substantially lower annual income.  About 81% of nurse practitioners work in physician practices but only 41% of doctors work in practices with nurse practitioners. Nurse practitioners see about 20 fewer patients a week and work around 8 hours a week less.  About 25% of nurse practitioners feel they cannot practice to the full extent of their training due to restrictive state laws or other factors.  There were very significant differences in views on the role of nurse practitioners, for example, 82% of NPs thought they should be able to lead medical homes and only 17% of doctors agreed.  While 64% of NPs think they should be compensated equally to doctors for the same services, only 4% of physicians hold that view.  And 66% of physicians think they provide a higher quality of service than NPs for the same type of primary care visit, but only 5% of NPs agree.  Physicians hold much less positive views about the effect of expanding the supply of NPs on the quality of health services.  All of this suggests that many doctors are as yet unwilling to surrender their opposition to further expansion of the role of NPs.  The research, of course, strongly supports the notion that nurse practitioners provide at least equivalent quality, at a lower cost.