When I wrote this blog, I hadsuspicions that this was the case, but not enough information toinclude it then. And did it happen – three days after my post. Nurse Practitioners (NPs) are being targeted very heavily as medicalboards lobby state legislators to limit what NPs can do and not do. If they continue to lobby for restrictions on NPs, you can almostunderstand what patients are going to say when they have to wait tosee a doctor when NPs are available. It isn't going to be prettywhen they learn why the NP cannot see them and they must wait manymonths to resolve a health problem. If you think emergency roomswill pick up the slack, this may or may not happen
This is some startling facts you needto be aware of and understand about the positions of our medicalprofessionals. Currently there are 18 states and the District ofColumbia that allow nurse practitioners to diagnose and treatpatients and prescribe medications without a doctor's involvement. On the other side, 32 states require a physician's involvement todiagnosis and treat or prescribe medications, or both. The NationalConference of State Legislatures reports that as of February 2012,245 bills had been introduced in various state legislatures relatedto changing scopes of practice. About 50 of these bills would affectnurses, including advanced-practice nurses. It looks like ourphysicians are out to hamstring their own profession, by shutting outthe people that could come to their assistance.
What are the issues? Nursepractitioners are a type of advanced-practice registered nurse. Theyare registered nurses who have also obtained a postgraduate nursingdegree, usually a master's degree. Doctor groups are claiming thatNPs will create safety concerns and must be restricted in their scopeof practice. At the state level, the battles are being waged by themedical boards and the legislatures to determine the scope ofpractice for non-physicians, including nurse practitioners. At thefederal level, the problems are on the NP's ability to be reimbursedfor the care they provide.
Because of the predicted shortage ofprimary care as the population grows and as millions of people becomenewly insured starting in 2014, one of the proposed solutions is toexpand the role of nurse practitioners in many more areas of thecountry, and to allow them to provide a wider range of preventive andacute health care services. Many areas of the country will bewithout medical care if the physician shortage becomes as severe assome are predicting. Rural areas will be particularly hard hit andresidents will face long commutes to see a doctor. Even some smallcities will have limited numbers of physicians.
The above map presently shows wherenurse practitioners are appreciated and valued and the states wherephysicians in general don't want them. I am pleased that my statestill values them.
Some of the problems inherent in thephysician shortage will be the compromise of a broad range of medicalservices. This will include initial valuation of new symptoms,ongoing care for chronic diseases, and many of the preventiveservices. If continued restrictions are placed on nursepractitioners, the absence of availability of primary care will meanincreased mortality, increased emergency department visits (if theseremain available), and increased hospitalizations at hospitalsdistant from the patient's residence.I wish there were maps available todepict the areas that the Health Resources and ServicesAdministration (HRSA) says that people are uninsured, isolated, ormedically vulnerable. The HRSA says it has identified roughly 5700geographic areas containing 55 million residents as being in primarycare health professional shortage areas. To satisfy the target ratioof one primary care practitioner for every 2000 residents, more than15,000 additional practitioners would be required. Primary careshortages will increase if the current trend continues.
For the last decade at least, there hasbeen less medical graduates entering the primary care arena. The payfor specialists is the biggest reason for the decline in primarycare. Some policy makers are urging that there be pay equality tobring more physicians into primary care. They are suggesting loanforgiveness programs for physicians who practice in under servedareas.
What many physicians are unhappy aboutis the increasing research that clearly demonstrates that patientswant primary care and this is more important that who is providingthese services. A careful review of 26 studies published since 2000found that health status, treatment practices, and prescribing wereconsistent between nurse practitioners and physicians. Two otherfactors that are important are – patients say they have higherlevels of satisfaction with their care from NPs, and NPs have abetter reputation than physicians when evaluating patient follow up,time spent in consultations, and other measures. I don't agree withthis, but it may be part of the equation to fill in the gaps inprimary care. “Nurse-led clinics mayprovide care in under served areas or meet the demand for moreconvenient care by providing a limited number of low-intensity,commonly needed services, in locations such as retail stores.”
Many advocates say that changes infederal and state laws need to be made to remove barriers to theadvancement of nurse practitioners. However, many physician groups,chief among them, the American Medical Association, assert thatencouraging patients to see nurse practitioners rather than primarycare physicians may put patients' health at risk. This assertion isnot supported by evidence and even the Institute of Medicine (IOM) isspeaking out in favor of allowing nurse practitioners to fill the gapbeing created by the primary care physician shortage.
“The IOMrecommended specifically that state legislatures reformscope-of-practice laws and regulations to conform to the NationalCouncil of State Boards of Nursing Model Nursing Practice Act andModel Nursing Administrative Rules, which outline scopes of practicefor advanced-practice registered nurses. It further recommended thatstate legislatures require fee-for-service plans within the state tosimilarly cover nurse practitioner services. At the federal level,the IOM recommended that the Federal Trade Commission identify stateregulations related to advanced-practice nursing that have ananticompetitive effect without contributing to the health and safetyof the public, and that states be urged to change such policies.”
“The IOMrecommended that Congress change the Medicare law to make coverage ofnurse practitioner services consistent with coverage of physicianservices. It further recommended that the Centers for Medicare andMedicaid Services clarify that hospitals participating in theMedicare program must allow nurse practitioners to have clinical andadmitting privileges and to be eligible to be on the medical staff.The IOM also endorsed the notion that the federal government shouldrequire plans participating in the Federal Employee Health BenefitsProgram to cover services provided by nurse practitioners operatingwithin state laws.”
Whether the Institute of Medicine'srecommendations will be enough to tip the scales for nursepractitioners, at lease members of state legislatures around thecountry have something to support changes and no longer have tolisten entirely to self-serving physicians.
Hiç yorum yok:
Yorum Gönder