Within the next several years, the Baby Boomer generation will continue to get older and require more health care. Under the Affordable Care Act, they will have the ability to get the health care they need, but will there be enough heath care providers to go around?
Nurse practitioners are fighting for independence in the health care field, and hope they, along with other mid-level health care providers, will be able to provide the aging generation with the assistance it needs. They have had more success with the passing of the Affordable Care Act because more patients are insured, worsening the doctor shortages.
Although nurse practitioners are given some degree of autonomy, they are arguing that it's not enough. Currently, in 19 states and the District of Columbia, nurse practitioners are allowed to treat patients and prescribe drugs. Another 19 allow them to practice independently with an agreement with a physician for some aspects of patient care. The other 12 states have some proposals floating around that grant more autonomy, but the current rules in place are considered restrictive by the American Association of Nurse Practitioners.
Many patients say that the level of care they receive from nurse practitioners is as good, if not better, than the care they receive from their primary care physicians.
"Typically, a visit with Bob will last two to three times longer than one with any of my other physicians," said Margo Grace of her Nurse Practitioner Bob Hobbs. "And I never feel awkward asking him questions, and he's always willing to take the time to answer them for me... I found that the care that I get here is as good or better than a physician's office."
She also described him as accessible and easy to talk to.
Grace is not alone in her feelings. The National Governor's Association found after examining several studies that nurse practitioners provide at least equal quality of care to patients compared to physicians.
In many states that require nurse practitioners to operate with a physician agreement, nurse practitioners have to jump through hoops to keep their practice running. Many times, their practices run the risk of shutting down if their partnering physician decides to retire or otherwise leave the state. Some doctors even charge nurse practitioners for signing collaborative agreements.
Physicians and the American Medical Association, on the other hand, strongly oppose nurse practitioners being given the autonomy to work on their own, citing the difference in education.
"The (AMA) encourages physician-led health care teams that ensure health care professionals work together as the ideal way to provide high quality and efficient care," American Medical Association officials said in a statement. "Patients win when each member of their health care team plays the role they are educated and trained to play."
Research has provided some support for physicians maintaining oversight to nurse practitioners.
In a study released in JAMA Dermatology, researchers found that an overwhelming number of mid-level providers - nurse practitioners and physician assistants - provided dermatological procedures that carried high risks to their patients including skin biopsies and radiology.
The American Academy of Family Physicians holds a similar position saying that nurse practitioners should work "under the direction and responsible supervision of a practicing, licensed physician."
"Granting independent practice to nurse practitioners would be creating two classes of care: one run by a physician-led team and one run by less-qualified health professionals," said a report by the academy. "Americans should not be forced into this two-tier scenario. Everyone deserves to be under the care of a doctor."
Nurse practitioners, however, understand the value of physicians and say they frequently rely on them for guidance even with the new laws in place.
Nurses have the tendency to become burned out if their motivation for being a nurse is linked only to wanting to help others. They tend to have high levels of commitment to their jobs according to a study presented at the American Sociological Association conference.
This motivation also explains the large number of nurses who are women since historically, women are known as the caregivers.
The study found, however, that if the nurse has other motivations instead of or on top of wanting to help others, they as significantly less stressed.
