One of the most interesting developments in the healthcare world revolves around the huge number of advanced practice clinicians and the role they should play in the delivery of healthcare. There has been significant pushing and shoving going on between family physicians (FPs) and nurse practitioners (NPs) as they obviously are fighting for the same patient. The FPs have no problem with NPs as long as they work for them or under the direction of a physician. The NPs are looking for much more autonomy and feel in many situations there is no need for this supervision. Take a look at this piece in the Wall Street Journal to familiarize yourself with the situation.
The issues raised in the article are both complex and interesting. Note that all of this takes place when there is a concern that full implementation of the Affordable Care Act, which brings more patients into the system, will result in severe physician shortages. We need more providers and many are pointing to the NPs and physician assistants as the most obvious solution to this problem. The argument raised is not about NPs seeing patients but rather whether they can work for themselves or under a physician’s supervision.
It is interesting how the data used by both sides is spun to make their points. The nurses agree they have fewer hours of training but it is more focused and not wasted on obscure areas; it is actually better for the patient. There is controversy over the data on nurses referring more to specialists and admitting more patients to hospitals which results in higher costs. Even the quality of care is debated. Note from the chart that this is not an insignificant issue as there is nearly one NP for every two primary care physicians in the country. It is interesting that the issue on income is never mentioned in the article and yet that is driving so much of the debate. If the FP, when romancing the “team” concept, declared there would be equality in decision making and equality in income, perhaps there would be less controversy.
The key here for the pharmaceutical industry is to try to figure out how to work both sides of the street. More decision makers and prescribers certainly should help business. The concern may come with whether NPs are stricter at following formularies, using generics or whatever and how that would hinder the sales of higher priced products. The industry has always benefited from physicians who feel they may gain some advantage for specific patients by using a product that is not first line on a formulary or treatment algorithm. Research should be done to see if NPs who are independent act differently than those under the supervision of a physician.
Perhaps there are some bigger lessons that could go beyond the NP/FP battle. Are there similar situations in your workplace where work is being protected for fear that lower paid employees may be able to replace higher level people? Are people allowed to stretch even without all the formal training? Could a lot of the work your sales representatives are doing be replaced by lower paid less trained customer service representatives? How about all the mundane marketing activities? The key is to try to free up time by allowing people to turn work they are overqualified for to lower levels in the organization and that in turn will allow for more innovation, strategic planning and higher level work. That by the way, may be the way FPs should be thinking. Instead of fighting to protect their turf they should be trying everything they can to improve the overall healthcare system and stretching their own role at the same time. There is so much to be done!