Wednesday, August 20, 2008

What a Wonderful World...

As nurse practitioner-staffed retail clinics continue to open and expand (despite what many recent reports say otherwise), they continue to fall victim to physician-centric comments undermining the competence and professionalism of other health care providers. Am I surprised? Not at all. It has all come to be so routine now. Take for example, a recent article written in the Topeka Capital Journal. The end of the article quotes a pediatrician's take (by the way, the American Academy of Pediatrics opposes the use of retail clinics - whatever that means) on why one shouldn't use retail clinics. The article goes on to say:

As for people who don't have insurance, Cain said there is always a place for them.
"We have plenty of places for people to get care," Cain said. When looking for a physician, Cain advised finding someone who has flexible hours and cares about patients. "I would find a doctor who can provide you with a good medical home," she said. "We specialize in the treatment of children. It's a whole different level of service you're getting."


That sounds like quite the dream world.

I'd like to know what places the uninsured or underinsured can go for care. Does that mean emergency rooms, urgent care centers, under-staffed and over-worked departments of health?

The term "medical home" gets thrown around a lot these days. A true medical home, would be a place that coordinates care, treats conditions and offers preventative care with the right team of providers at the right times and places. It would not mean a solo practitioner as the quote above suggests.

It has become commonplace to end these types of articles with a jab to nurse practitioners. Here they talk about the "level of service" which is exactly that, a jab. Nurse practitioners and those in retail health have and continue offering high quality, compassionate and cost-effective care. Of course this must make some worry since a recent report from the University of Michigan C.S. Mott Children's Hospital National Poll on Children's Health stated:

"Nearly two-thirds of the parents whose children had already used a retail clinic report they were likely to use a clinic again."

Everyone knows that there are plenty of patients to go around. There are good reasons why people are choosing to receive care from a retail practitioner. Those include: convenient walk-in hours & locations, easy access to a healthcare professional, transparency in pricing, print outs of each encounter given to patients at the conclusion of visits and quality care to name a few. The clinics would cease to exist if the care rendered was substandard - and that doesn't appear to be happening. Maybe we can start working together in the interest of patients to attain the highest quality of care rather than protecting turf. Much can be learned from each other. Oh, if it were only that easy. What a wonderful world it would be.

Sunday, August 10, 2008

Ready, Willing and Able

An article about physician assistants and nurse practitioners appears in the NY Times Jobs section. The article does a very good job of explaining both professions though I would disagree with a few of the statements.

Another important difference is that P.A.’s are generalists, while nurse practitioners train in a specialty like family medicine or women’s health. As a result, P.A.’s can switch fields more easily. - I would say that isn't necessarily true. Since the majority of NPs are trained in family health, I think it's just as easy for these FNPs to transition into different roles.

To patients, the two roles can seem very similar. Salaries can be similar, too. The average total income for physician assistants in full-time clinical practice is about $86,000, according to the P.A. academy. The average total income for nurse practitioners is $92,000. - average salary of $92k? I think that sounds pretty high. Most of the NPs that I know are in the $70 - $90k range and I am referring to the metropolitan New York area. A quick jump to salary.com is consistent with that range. There are higher paying jobs in large cities and they are usually affiliated with large hospital systems. The good news is that salaries are on the increase as the demand for advanced practice clinicians is growing.

Finally, the affectionate term of "mid-level" provider is used in the article. I guess I can't fault them since the term is used commonly to collectively describe NPs and PAs. In reality, it is a poor descriptor. It insinuates the care we deliver is somehow not as good as say, a "high-level" provider (not sure who that would be and how one would become such a provider.)What would that make RNs, EMTs, Medics, respiratory therapists, etc - "low-level" providers?!?

Overall, it is great to see these types of articles in the media. The better that the public is educated about our roles, the easier it will be to practice without barriers. Patient's are increasingly choosing to have care delivered by NPs and PAs and will continue to do so as the abysmal health care system sputters along. We afford an imediate solution to this crisis and are ready, willing and certainly able.