Physician Vs NP: Five Opinions


Earlier this week, the American Academy of Family Physicians released a report entitled Primary Care For The 21st Century: Ensuring A Quality, Physician-Led Team For Every Patient. I talked about this report on this week's podcast. Following the release of this report, there has been a lot of discussion, including this twitter chat following my podcast.

At issue is the question about who should be the leader of the health care team - The Physician or the Independent Nurse Practitioner. There have been long form essays written about this report, and I will include links and quotes below from the five I think are interesting, and you can decide for yourself how you feel about this issue.

Nurse Practitioners No Substitute For Physician Led Team: Roland Goertz, MD from AAFP

  • Granting independent practice to nurse practitioners would create two classes of care: one run by a physician-led team and one run by less-qualified health care professionals. Physicians are required to complete 16,000 more hours of training than nurse practitioners
  • At a time when the AAFP is advocating a team-based approach to health care to improve outcomes and lower costs, some nurse practitioners are eager to go it alone. Our report makes a strong statement that the patient-centered medical home model is designed to be run with a physician leading a team of health care professionals.


From American Academy of Nurse Practitioners: Angela Golden, DNP, FNP-C

  • The American Academy of Nurse Practitioners strongly supports patient-centered and team-based care models. However, the AANP believes that AAFP's efforts to link these evolving models of care with the licensure of nurse practioner practice are misdirected and out of step with today's environment.
  • Making full use of the NP workforce is a critical piece of a multi-pronged solution to address the urgent need for health care access in our nation. The ongoing attempts by the AAFP to limit the ability of NPs to practice to the full extent of their education and training only serves to increase the already overwhelming hardships placed on millions of Americans who are struggling to gain access to high quality health care.


Nurse Practitioners, Scope of Practice, and Turf - CKRN

  • Frankly, I find this statement condescending and disheartening. First of all, the statement over simplifies a much more complicated issue. Yes, I believe in removing barriers to nurse practitioner scope of practice. One practical reason for this is that when nurse practitioners are authorized to diagnose and prescribe, they can bill more comprehensively for services. If nurse practitioners cannot bill for services, they aren't useful additions to the health care team.
  • The way the AAFP has presented their argument leaves me throughly disheartened... With one statement, the specialty that made me believe in the future of healthcare has made me feel like a second class citizen... Believe it or not, that attitude doesn't make me want to collaborate.


The Business Case For Nurse Practitioners - Brian Klepper, PhD

  • Why has AAFP taken a public stance against nurse practitioners extending primary care services, but ignored specialists usurping a significant portion of primary care business? An August 2012 study found tht 41% of primary care office visits were provided by specialists.
  • Primary care is in decline because it has been compromised by a health care industry that wants direct patient access to lucrative downstream services. But primary care's leadership also has complicity, because it has failed to compellingly convey primary care's value and allowed others to define it.


Patients Are The Real Leaders In The Patient-Centered Medical Home - Kevin Bernstein, MD

  • Our medical home team has a team leader. At any time, it can be a nurse, a physician, or whoever is available to take charge and make sure our patients are cared for. That's the point.
  • Whether or not it needs to be a physician or nurse practitioner - the evidence is definitely lacking. However, when looking at the IOM report for nursing and the AAFP report for the future of primary care, the only thing that really sticks out to me is the idea we should be working together in collaboration. The national organizations can spin their reports and backlashes however they would like. Unfortunately, this is what media will do for a news story.
  • Who is the leader in the Patient-Centered Medical Home? The answer is easy - Our Patients. And they deserve the right for increased access to a team of providers - physicians, nurse practitioners, not practicing independently - who all need to be leaders for the patient's ability to achieve a healthier life.