Reporting on health and quality of life in South LA

Survey: Doctors, nurse practitioners disagree on scope of nurses' role

06 - UMMA Clinic Nursing

Christopher Okula/KPCC

Rosaura Guizar, a patient at UMMA Community Clinic in South Los Angeles, is examined by Simmi Gandhi, a nurse practitioner at UMMA. A recent survey suggests that most nurse practitioners believe they should be able to lead their own practices – and most physicians disagree with them.

Ask nurse practitioners if they should be allowed to lead their own medical practices, and more than 8 in 10 will say yes. That's already happening in some parts of South Los Angeles, an area that's already lacks resources to fully meet the area's health care demand.

But ask physicians that same question, and not even 1 in 5 are comfortable with that idea.

That's according to a new survey published in the New England Journal of Medicine, which the authors wrote suggests that "physicians and nurses do not agree about their respective roles in the delivery of primary care."

A recent congressional report estimated that the U.S. is short about 16,000 primary care doctors. By 2025, that gap is expected to grow to about 52,000. Mid-level providers like nurse practitioners and physician assistants are expected to help fill that void nationwide, especially as the Affordable Care Act expands access to health care via the statewide insurance marketplaces and the Medicaid expansion.

At UMMA Community Clinic and St. John's Well Child and Family Center in South L.A., mid-level providers – including nurse practitioners – play a critical role in helping these area clinics see as many patients as possible.

The survey from the New England Journal of Medicine evaluated nearly 1,000 responses from nurse practitioners and physicians, with slightly more doctors answering than nurses. Virtually all nurse practitioners and 76 percent of physicians agreed that nurses should "be able to practice to the full extent of their education and training." Majorities from both groups also said increasing the number of nurse practitioners would expand access to care.

But in a statement, Karen Donelan, the lead author of the report, said she was "surprised by the level of disagreement reported between these two groups of professionals." 

Some of the findings include:

  • 82 percent of nurse practitioners said they should be able to lead their own practices; only 17 percent of physicians agreed.
  • 64 percent of nurse practitioners said they should be paid as much as doctors for providing the same services; only 4 percent of physicians agreed.
  • About 2 in 3 physicians said they provide higher-quality exams and consultations than nurse practitioners during primary care visits; more than 3 in 4 nurse practitioners disagreed with that.

The authors concluded that policy proposals aimed at expanding nurse practitioners' scope of practice in primary care are "controversial."

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