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American Medicine

Is this your doctor or nurse practitioner, and does it matter?

With the expansion of health insurance from the Affordable Care Act and other insurance reforms, more patients will have access to physicians.  In order to accommodate this increased burden on the healthcare system and increased availability of higher quality care for patients, there will be more widespread use of nurse practitioners.

A recent article in the New England Journal of Medicine by K. Donelan and co-authors (New England Journal of Medicine 2013, Volume 368, Page 1898) sheds more light on this increasingly prominent component of medical care.

Physicians and nurse practitioners were surveyed to determine their impression of care given by physicians and nurse practitioners.  The results indicated that both nurse practitioners and physicians indicated that there would be better access to medical care, and better access of health services in general, by expanded use of nurse practitioners.  However, there was less confidence that use of nurse practitioners would have a beneficial outcome on safety or effectiveness of care.

However, the most striking finding was that there was a marked disagreement between physicians and nurse practitioners as to whether or not physicians provide a higher quality examination and a higher quality consultation than nurse practitioners performing the same type of primary care visit.  Although 66% of physicians said physicians provided a higher quality examination, only 25% of nurse practitioners said physicians were better.

This difference of opinion between physicians and nurse practitioners represents a fundamental judgement by each of the groups that their care is best.  Since physicians and nurse practitioners must work together to provide high quality coordinated care, having different strongly held opinions in each group about whose care is “best” can lead to disagreements in methods of patient care and operations within offices and clinics.  More importantly, it may lead to increased staff turnover in situations where the physicians believe their care is better and where nurse practitioners believe their care is best.

Here are my tips for your care:

• Try to choose a physician’s office where the physician uses nurse practitioners to increased access to medical care, and where the physician is committed to backing up the nurse practitioner and allow access to the doctor when appropriate.
• Make certain both the nurse practitioner and the physician are both willing to answer all of your questions and concerns an each visit.
• When nurse practitioners are working in the office, be certain that you ask the nurse practitioner during your visit if the doctor needs to help answer any questions or help make decisions about tests or treatments (and find out when the doctor will do it).
• If you are unable to see the physician when you still have questions about your care, seek a second opinion from a different physician who will provide you with the support that you need.
• Nurse practitioners give outstanding care when they are appropriately monitored by physicians under whom they are working.  Make certain that you have good quality care by knowing the doctor is closely supervising the nurse practitioner.

For more information about nurse practitioners and physician assistants, see my book, “Surviving American Medicine”.