Professionals - a nurse practitioner or a physician assistant who can diagnose and treat conditions, while supervised by a physician, will be a great help in bridging the shortage of primary care doctors who will be needed to care for the additional 30 million Americans enrolled under the Patient Protection and Affordable Care Act.
"We're going to need an enormous amount of workforce to take care of the number of patients out there. The emergency room takes a lot of the care, but if you think of the explosion of uninsured individuals being dumped on, if you will, the health care plate, we're going to need a lot of practitioners to take care of them," said Dr. Kenneth Harbert, dean for the School of Physician Assistant Studies at South College.
Although Schools like South College have been adjusting programs to increase graduates, it seems unlikely that they will be able to meet the demand.
Sharon Adkins, MSN, RN, executive director of the Tennessee Nurses Association said that in 2010, practice nurses took over more than 58% of the Medicare services in Tennessee.
"So nurse practitioners do provide a lot of care in this state," she said. "They should have full practice authority." Each state has its own specific rules; in Tennessee nurse practitioners can provide care except for prescription of medicines or invasive procedures.
Efforts are underway to ease laws and allow nurses and assistants to use the full extent of their education and training. "We are constantly trying to remove barriers to the scope of practice. The organized medicine in this state does not embrace that concept," said Adkins. "Existing research suggests that NPs can perform a subset of primary care services as well as or better than physicians. Expanded utilization of NPs has the potential to increase access to health care, particularly in historically underserved areas," the paper states. Nurse practitioners and physician assistants are important in the care delivery team at Summit Medical Group, Chief Medical Officer Dr. Randy Curnow said.
At Summit Medical Group, the number of advanced practice nurses and assistants increased to nearly 100, while the number of physicians has remained relatively flat at just over 200. "It's a model that has worked throughout the country and one of the ways we can provide better care," Curnow said. "There are not enough primary care physicians. But I don't think things are hopeless. We can continue to strive to provide better care, efficient care with higher-quality care under a team-based model."
"We're very much in the transition of working more toward an interdisciplinary educational system," said Stowers, president of the American Osteopathic Association. "All of these students have to work together to work in a team to come up with a solution for that patient — in other words, a health care solution. That's the kind of interaction that's going to have to happen in the real world if we're going to provide high-quality, efficient health care."
"I think we've got some excellent individuals who are focused on those areas for the future. The challenge will be how we started dealing with regulation and legislation to get more health care providers out there to do more, really understanding the role they can provide rather than creating silos where we have medical on one side, nursing on the other and physician assistants in the middle," said Harbert.
"All of us are trying to do what we can. No one has a crystal ball to see exactly what health care predictive models will be. I think what we're trying to do is provide educational excellence. The product we're turning out is superb. The question is are we turning out enough and are more going to be needed."
Hannah Punitha (IRDA Licence Number: 2710062)
Carly Harrington, June 2013