Wednesday, May 26, 2010

Proceed with Caution

One can find a myriad of commentaries written on the future of primary care now that health insurance reform has passed. Many of these refer to nurse practitioner led clinics and how this can be one possible solution to care for the millions of Americans that will now have health insurance. Of course, I am a proponent of NP guided care and believe that patients form long lasting partnerships with NPs to help make choices about their health and wellness.

As I've stated before, NPs are not brand new to the health system and have a 30+ year history of providing high quality care. A number of NPs right now own their own practices while others can be found in school-based clinics, hospitals and physician's offices. Unfortunately, NPs face many of the same types of issues that has driven physicians out of primary care. Dr. Karen Li wrote a wonderful column, "Why I Left Pediatrics," that describes the reality of the barriers in health care.

We simply cannot expect NPs to fill the void in primary care settings while maintaining the widespread dysfunction of the health system. It will only be a losing battle as we try to care for our patients. I do however, remain optimistic that we have taken an incremental step in the right direction. We realize that maintaining the status quo is no longer an option. NPs will hold increasingly significant roles in the system. To avoid ending up in the same situation, we need to ensure that all stakeholders are at the table as we write the next chapter in health care.

1 comment:

BarbaraC. Phillips, NP said...

You are so right...we must all be at the table.

Right now, there are too many barriers that allow us to function to the full extent of our education and training.

For NPs in their own practices this includes rules around collaboration (we all collaborate regardless of the rules when needed!) and insurance companies that will not credential NPs, or they do so at a lower rate of reimbursement to the NP and higher copay to the patient. Thus someone who wants to see an NP, and has insurance are blocked if they want to use that insurance.

Frustrating to say the least.

Barriers and discrimination comes in all sorts of flavors. And it needs to stop.

Barbara C. Phillips, NP