A Changing Landscape

With the passing of the recent historic health insurance reform, the focus has turned (see here and here and here) to how will the system deal with the influx of approximately 31 million newly insured seeking access to care. All of these articles address the current shortage of primary care physicians in some way and creates a sense of urgency for patients to try and secure one before access becomes crippled (as it has in Massachusetts).

What these articles fail to address is the true potential that NPs and PAs have to pick up this slack. There is this incorrect assumption that NPs, facing the same barriers in primary care, are flocking to lucrative specialties. Fortunately for patients, this is not the case. A recent survey by Advance for Nurse Practitioners, reveals that most of the NPs polled work in predominantly primary care or primary care-type settings. Also a very informal survey of the NPs that I know has a similar result.

So what does all this mean? The good news is that potential solutions already exist to help with this dilemma. I believe that primary care physicians in the trenches largely recognize this and together we are trying to innovate the system and provide high-quality care with the limited resources we have. We are examining new models of delivery and determining how technology can work to our advantage and improve communications among patients and enhance the continuity of care. The bad news of course is that the aforementioned is easier said than done. Opposition to NP directed care and turf concerns are abundant. State laws and regulations regarding NP practice are out-dated, not evidence based and vary from state to state leaving a patchwork of rules and regulations further impeding access.

I remain hopeful that we will slowly improve the system so that these newly insured as well as already insured will have access to high-quality whole-istic care, will take a meaningful and responsible role in their care, thus producing better outcomes than ever before. It will not be easy and it will be with on-going debate but the landscape of health care will be different in the near future than it is today. It has to be.