You could see this coming.  Last week the American Academy of Family Physicians put out a policy statement where they are pushing back against the expanding role of nurse practitioners.  They raise some legitimate issues.  The nurses are trained well in certain areas but have nowhere near the breadth of training and experience as the primary care physicians.  There is a shortage of primary care physicians and this problem has been made even worse by the Affordable Care Act, but the FP’s view is that it is wrong to fill this void with NPs working independently.  They are adamant that this will lead to two tiers of patient care.  With more and more responsibility for the success of healthcare reform being placed on the PCPs, they feel it is critical that there are not fractioning movements taking place simultaneously.  I love the comment from the nurse who went back to school to become a physician who said she had no idea how much she didn’t know.

Perhaps the most important argument made is that the widespread use of non-physician independent providers could disrupt the extremely successful patient-centered medical home (PCMH) movement.  PCMHs have become widely adapted across the country and the benefits are outlined in this AAFP piece.  In brief, PCMH is an innovative program to improve primary care.  It involves the use of clear and specific criteria to help deliver coordinated care for a patient that is team oriented and data driven.  As the name would indicate, the patient and their family are the center of the care and they are assured to get help when and where they want it. This care will be delivered in a culturally and linguistically appropriate manner.  AAFP feels that nurses need to be one of the team players working under the leadership of a PCP rather than providing services outside the system.

To outsiders this may seem like a turf war but the stakes are extremely high.  The pharmaceutical industry needs to be aware of the issues on both sides.  It is very important that representatives and marketing professionals clearly understand the PCMH concept, including how this plays with Accountable Care Organizations.  Our customers are trying to maneuver their way through some complex changes that we all hope will lead to a much more efficient and effective healthcare system.  We need to clearly recognize the different situations where NPs work, which is dependent on their geography and even their employment relationship.  Perhaps it could be a mistake to treat all NPs the same. It is important that the industry respect the concerns of all parties and be delicate with the way they interact with both types of providers.

Perhaps the best starting point is to talk with customers about the situation and ask how they would like the industry to work with them.  How could we make their lives easier and allow them to better manage their patients using our products?  We need to learn their language and talk their talk.  I always get in trouble by referring to FP as family “practice” rather than family “physician” as I am reminded that what they do is real and not practice.  The more everyone understands the ACA, ACOs and the PCMH concept the easier it will be to relate to our customers.  More than anything else it is important to be sensitive to everyone’s concerns.  Ignorance is not bliss.

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