As nurse practitioners in many states, a New England Journal of Medicine released Wednesday documents聽a deep chasm between how doctors and nurses聽regard the issue.
The study found the two groups overwhelmingly agreed that nurse practitioners should be able to practice to the full extent of their schooling and training. But doctors were less likely to聽concur that advanced practice nurses should lead medical homes, which deliver team-based, coordinated care to patients. Only 17 percent of the 505 primary care physicians聽 surveyed agreed with that notion, compared to 82 percent of the 467 nurse practitioners surveyed.
The two groups also disagreed聽about whether聽nurse practitioners should be paid equally for providing the same health services. More than 64 percent of nurse practitioners agreed with the idea of equal pay, as opposed to less than 4 percent of doctors.
The debate over the role of nurse practitioners has intensified as a result of concerns over a shortage of doctors as聽an estimated 25 million people gain insurance under the health care law.聽 Nurse practitioners argue they can fill some of those needs if they are granted greater scope of practice.
That debate is reflected in the study鈥檚 finding about the groups鈥� conflicting views聽about the quality of care provided by doctors versus nurse practitioners. When researchers asked whether they felt the quality of care聽provided by聽physicians in exams and consultations was higher than that provided by nurse practitioners, more than 66 percent of doctors agreed, while 75 percent of nurses disagreed.
鈥淲e鈥檝e done a lot of comparative surveys with health professionals but we鈥檝e just never found gaps this big,鈥� said , an assistant professor of medicine at the Harvard School of Medicine and the study鈥檚 lead author. 鈥淲hen we get on the ground and we survey the people actually doing the work and working together, we see some of those professionals come closer together. We didn鈥檛 observe that here.鈥�
Donelan pointed out that most nurse practitioners in the study 鈥� approximately 75 percent 鈥� said they聽are already practicing to the full extent of their training. Survey respondents who did not have this opportunity blamed their limited practice on state restrictions, hospital regulations and work setting.
During an interview, Donelan also said she was surprised by the level of disagreement in regards to the quality of care, since previous research findings have suggested little variation in the work done by聽 nurse practitioners and primary care doctors.
During a , David Hebert, the CEO of the described the safety concerns raised by physicians as聽a 鈥渢otal red herring,鈥� and added that 鈥渘urse practitioners have been practicing safely and providing great outcomes for decades.鈥�
, the president-elect of the , , emphasized his support for a more collaborative approach between the two clinician groups, noting their roles are not interchangeable.
Differences aside, Donelan鈥檚 study shows that the majority of practitioners聽in both groups agreed that increasing the number of nurse practitioners would improve timeliness of care. However, less than a third of doctors said such an increase would boost safety or聽effectiveness of care.
Nurse practitioners, on the other hand, overwhelmingly felt such an increase would improve care. Close to 81 percent, for example, thought the growth would improve access to health care for the uninsured and 77 percent聽said it would result in聽lower health care costs.
鈥淎s a team, this kind of inter-professional disagreement is not a good thing when we鈥檙e trying to achieve better teamwork,鈥� Donelan said. 鈥淭he conflict over roles has got to be worked out so that it鈥檚 clear for patients when they get their care.鈥�
Moving forward, she said she hopes that both doctors and nurse practitioners will acknowledge their differences and聽bridge the gaps that keep them from working together.