The New Health Dialogue

With a massive health care coverage expansion on the horizon, making sure we have enough health professionals for the 32 million newly insured is a big priority. We'll need a solid foundation of primary care providers, not just to expand coverage but to create a high-value, well-coordinated care system. But as we’ve written before, primary care doctor shortages (in some places at least) are a problem, even before the system starts absorbing all those new patients.

What are the solutions? The new health reform law makes numerous investments in the health care workforce, many focused on primary care. There is also a move to increase the role of allied health professionals -- including nurse practitioners and physician assistants -- to fill primary care gaps. As Sabrina Corlette of the National Partnership for Women and Families said at our forum on implementation this week, alleviating the shortage of primary care providers will in part mean allied health professionals should be practicing to the "top" of their license. In other words, doing everything they've been trained to do.

State laws about what nurse practitioners can and cannot do vary, but in 28 states, lawmakers are weighing expanding NPs role and privileges, reports the AP. Nurse practitioners argue that they can do a lot of what primary care docs do, and they would like the authority to practice without the supervision of a doctor, and to be allowed to prescribe narcotics. Some doctors are fighting the bills, arguing that nurses don’t have the necessary expertise. But, according to the AP, nurses counter that they are perfectly qualified to diagnose patients’ illness and prescribe treatments -- and they know when it’s necessary to refer patients to a doctor or specialist. Nurse practitioners get paid less per office visit, but are able to spend more time with patients per visit. Studies suggest that nurse practitioners and physicians are about equal in their ability to provide quality care and manage patient health over time, writes the AP.

Some of the workforce provisions in health reform law relate specifically to bolstering the nursing workforce. As outlined by the Associated Press, some of the major ones are:

• $50 million to nurse-managed health clinics that offer primary care to low-income patients.
• $50 million annually from 2012-15 for hospitals to train nurses with advanced degrees to care for Medicare patients.
• 10 percent bonuses from Medicare from 2011-16 to primary care providers, including nurse practitioners, who work in areas where doctors are scarce.
• A boost in the Medicare reimbursement rate for certified nurse midwives to bring their pay to the same level as a doctor's.

"We're constantly having to prove ourselves," said Chicago nurse practitioner Amanda Cockrell, told the AP. She tells patients she’s just like a doctor -- "except for the pay."