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Obamacare Means Expanded Roles for Nurse Practitioners

Posted By: Alex Kecskes In: Healthcare & Medical

As Obamacare draws millions of previously uninsured Americans into the healthcare system, the shortage of physicians will become increasingly acute. So who will care for this avalanche of new patients?
State laws restrict the practice of medicine and those who are allowed to prescribe medications to licensed physicians. This may be changing as states expand the role of non-physicians.
Dr. Amesh Adalja, a quadruple board-certified physician notes that for many conditions, a nurse practitioner may begin to fill the gap. Using non-physicians to provide care in certain instances provides increased access to healthcare and may even reduce the cost of healthcare.
Predictably, physician trade associations have expressed their opposition to this physician-independent practice of medicine. Limiting medical practice to only state-licensed physicians limits a patient’s healthcare choices, forcing patients to opt for the costlier services of a physician. Yaron Brook and Don Watkins, authors of a Free Market Revolution, feel that the current physician licensing laws are simply “a way to establish an anti-competitive guild system.” The system is kept alive by laws that tout patient safety and by physician-paid fees to state medical boards to the tune of $6.5 billion a year. While medical boards certify physicians, these certifications don’t guarantee a physician’s proficiency. This is why hospitals and third-party payers frequently insist on additional qualifications before hiring a physician or paying for care at full rates.
Expanding a nurse practitioner’s authority to treat patients has been opposed by the American Medical Association (AMA), the American Academy of Family Physicians, the American Academy of Pediatrics and the American Osteopathic Association, which all support direct supervision of NPs by physicians.
Physicians may have to give in as Obamacare kicks in. "That horse has already left the barn," says Linda Aiken, professor of nursing at the University of Pennsylvania School of Nursing and director of the Center for Health Outcomes and Policy Research. "With Obamacare coming in and millions of people getting insurance, there is no other way to provide them with reasonable access in the short term except to expand the role of NPs and physician assistants (PAs). It takes 20 years to train a doctor, so there isn't any alternative." 
Clearly, a physician’s expertise and training is preferred for complicated medical conditions. That said, other simple conditions could be as effectively served by a physician’s assistant, a nurse practitioner or a nurse midwife.
While the government should “watchdog” physicians who defraud patients or materially misrepresent themselves, it should limit its role in the provider-patient relationship. This means allowing patients to seek the help of a physician’s assistant or nurse practitioner, without being hamstrung by unwieldy licensing laws and guild-minded state government medical boards.

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Posted by: Shannon E. Whitten NP-C
I am offended that it is thought we can only manage simple conditions.  I function as a PCP with physician collaboration should it be required but typically if a patient is too complex for me they need a specialist or a hospitalist at that time.  I manage over 600 of my own patient panel and provide excellent quality care I am quite capable of managing problems from acute sinusitis to CHF.  I have critical care hospitalist training and believe me am a capable primary care provider.  The need for NPs to provide preventive and managment of disease states is very obvious in rural Georgia.
Posted by: Cindy P
An NP has an 'overseer' that reviews and signs charts and is available for consult.  This is the same as a resident.  How many years does an NP have to go through this 'residency' before it is recognized as not just the same, but overkill as compared with a resident?  
Posted by: Ricardo P
It is a good idea because many patients who go to clinics require primary care. Nurse Practitioners are as qualified as many physicians and are as capable of providing care to patients. New regulations should give them more authority to prescribe meds.
Posted by: Michelle L
The sad truth here is that many physicians do not know the scope of practice of the NP. They also do not realize that many NPs have several years of expert nursing practice prior to going into the field of nurse practitioner. We know our limitations and that if we see a patient that requires care beyond our scope, we consult. Simple as that. We are not trying to take away their bread and butter. The problem is that the vast majority of medical school graduates are not going into family practice because it just doesn't pay. We are filling a gap of medical care for the better good. They should not feel threatened by independent practice. It is there because NPs have proven that they have the ability to give competent care for patients in whatever population they serve and due to there being large rural areas that are unable to recruit physicians. We get our CMEs the same way they do and many of us do on a monthly basis to keep up on the latest changes in evidence-based medical care. If anything, Physicians should embrace the NP, and take them under their wing, mentor them, because the bottom line is we as Americans should be able to provide the best care to the public as a whole.
Posted by: ANNETTE G
Posted by: Rosalio M
is very interesting ,that situation hapenned many years ago ,so ,tyhe goverment option was import physician from other coutries ,giving a exam lest hard ,nemed..FLEX ,not the usualy USLME ,you see the fenomenon of physician practicin medicine,later ,they produce USLME very hard to stop foreing graduated to practice in USA.i bilive so obama care is looking for another exsodo of foreing graduated physician..
Posted by: Monica_d
I think we need to start thinking about what benefits the PEOPLE, and not just the providers. Obamacare is for people to "care" about their healht. Period.
Posted by: Betty D
I have been thinking of going into the FNP program and have been told of these restrictions; however, if the community is going to have adequate health care, it would seem that the FNP and PA's are going to have to have more authority. Is this going to be a done deal with Obamacare?
Posted by: Alex Kecskes
Join the ANA (American Nurses Association) for more info on training and certifications. Also look into the American Association of Nurse Practitioners (AANP)   
Posted by: Tim R
All practicing NP's, PA's Paramedic's and EMT's have to have a Doctor for medical control or Director. You cannot put someone just out of school into patient care without a medical director.
Posted by: David Y
I'm not sure if you realize how the licensure for Nurse Practitioners is set up, so I'll provide you with some insight. Currently in most states, NP's or ARNP's require a PhD. Those who have already achived the status of ARNP with a Master's degree are grand-fathered in. However, in most staes, including Florida, any newly licensed ARNP requires a PhD. Also remember, they usually have valuable clinical experience and in many cases function very much as a Physician, especially when treating and managing chronic diseases such as diabetes, hypertension, CHF, COPD. The most valuable part of their nursing experience is  caring for their patients and actually educating them so their patients would more likely follow the treatment plan.   
Posted by: David Y
I have been working in health care for almost 20 years. I have seen all of the problems and costs associated with people who do not receive timely or consistent medical follow-up usually associated with the cost of care. Since the system was set up to primarily serve those who are insured, it only makes sense to insure those who otherwise would have none. I can't believe you don't realize how much money we've been throwing down the toilet for people who have chronic diseases that are not diagnosed or controlled and become very costly complications. It's better to pay a couple of dollars up front. Because we're already hemorrhaging from what's been going on.
Posted by: Annie W
I hope with expanding nurse practitioner’s authority to treat patients that APN's, PA's and nurses in general get the respect  and compensation for the great job they do.
Posted by: Gayle B
In Italy a PharmD (Doctor of Pharmacy function just like an MD, same thing goes for Costa Rica, Pharmacist's can get a special certification in Patient assessment and fill this gap too, I don't understand why pharmacists are not considered health care Proffesionals like ARNP's, they spent 6 years in school, longer than an ARNP!!!  
Posted by: Connie E
The NP isn't trained to Dx or TX people, period!! TX/DX is extended  & never dealt with-which increases healthcare costs!  Disability is welfare-go to work as the older generations have! No free ride!! Why give free what we work for & are now denied!! Stop extending life to keep NS homes full!!Take care of your own-as older generations have!! All Ns homes are hell holes; you want a report, I will give you one that will shock you. 20 yrs a nurse & still shocked at the lack of compassion 4 nurses by nurses; & Tx of patientsby MD's,Ns & healthcare staff. I observe poorly trained Ns kill pts most shifts; or RT, occ. MD's. MD's are underated, over worked & forced to trust a nurse with 'internet credentials.' Obama needs to be put in a ns home-disguised of course, or in a mental word-the worst horror! (not inc. prisons) He is clueless-like most polititions! Get real!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Posted by: Glory A
i belive expanding the nurse practictioner to treat patients will help a great deal in the healthcare industry.
Posted by: Kim W
You should have included Physician Assistants in this article.  NPs are not the only mid-level providers whose scope of practice will enlarge due to Obama Care.
Posted by: Tim E
Mandatory collaboration by MDs/DOs of NPs is simply a constraint of trade and needs to be abolished.  17 States plus DC already have full practice authority for NPs and 11 more states have new bills pending supporting approval for NPs to have full practice authority with no mandatory collaboration requirements. (This includes NY). We need to look at the outcomes folks. For their established scope of practice, the NP does as good a job, if not better than  the MD. There are over 100 studies over the last 40 years that support this fact. The fact that physicians do go to school longer and come out with more debt is an interesting fact, but irrelevant to the argument. If we can see a better outcome using less expensive resources, we should use them. It just makes good business sense. ACA will require more primary healthcare providers and NPs are willing and able to help fill the gap.  The sooner we stop arguing about who is better, the sooner patients will see improved access to  needed healthcare services.
Posted by: Joseph C
When I was in the Navy, it was routine to go to sick call and be see by a hospital corpsman for most common ailments.   
Posted by: Margaret S
As a retired 40year+ RN, I have been the team player who respected the process that expected me to evaluate and anticipate the complex needs of my patients and deal with indifference and entitlement from MDs. We will change Healthcare for the better as we always have.
Posted by: Margaret M
To limit patients by forcing them to see only Dr's, limits the system and the patient. The wait time for a Dr could result in more severe illness and even death.
Posted by: Rocio R
I agree with expanding the laws for PA's, especially in GA. However, as a PA i feel having a physician along is most beneficial.
Posted by: Joe A
Our Nurses are already overworked and understaffed and they're going to be loaded with more responsibility? Obamacare is an Abomination not only to our economy but to the Medical Professionals as well.
Posted by: REGINA P
i want to the hospital last sat and the pa acted like she didnt know what she was doing .  the meds she gave me i refused to take because they wasnt right to me
Posted by: Paul  T
It`s a good ideal. As anX navy corpsman,I worked.with patients  sholders in the.Dispensary.We any other Dr.would do.With the guidence. Of a Dr.For any,consult. that Nessaryn. As many.Dr.`s do all the time. In there pratice. Simular,to the EMTDoes, and give care for paients . Allowing. Drs.To treat the more.Paients.              
Posted by: Jerry P
Nurse Practitioners and P.A.'s are the ideal caregivers for the high cost frail elderly with multiple chronic conditions- delivering the bulk of their care in their home.  It is still a good idea for mid-levels to have a collaborating physician backup for the times when more knowledge is required.  ACO's are going to drive a lot of the care to the home- using N.P.'s and P.A.'s.
Posted by: vincent s
i think this country will go broke- with  the obama care kicks in.-but i maybe wrong. and i do not think it right for obama to force the people of this great country to go along with his obamacare.and if we dont then we will be fine.we are a free people of this country.i hope i am right on this to.this country does not belong to obama.
Posted by: Eileen P
I have worked in the healthcare industry for 26 years.  In all of my positions, I have interacted with nurse practioners and physician assistants.  I think they are well trained and can handle many of the issues in a physician's office.   Patient care will not suffer is there is adequate communication between providers.
Posted by: Beverly C
You have your facts wrong. Physician Assistants prescribe medications. They also see patients autonomously with supervision by MD. The only change necessary to help in the upcoming shortage is to increase the number of PAs an MD may supervise.
Posted by: Beverly S
I have an associate degree in Medical Office Specialist. This I am having problems getting employment. What can I do to enhance my schooling in the medical field? Ex. Phelbotomy. Or nurse but many nurses' that I know can not get employment. I am very concerned but when I try to help and to further what I love to do there are always road blocks. Appreciate a reply. Thank You
Posted by: Rose V
I like the idea of NP's and PA's being able to care for patients and prescribes scripts and treatments.I do not like the implication that NP's and PA's shoudl get paid less for the same work as a physicain and I do not like that the article implies that APN's can't handle complicated cases.
Posted by: Andrea T
It takes 20 yrs to train a physician   how long do you think ittakes to train a physicians assistant or an  nurse practitioner?
Posted by: Nettie H
I have always been of the opinion we as NP's really do not need MD's to supervise us. Collaboration sure.
Posted by: Chris G
NP good option. Most PA's not enough training, not equipped with knowledge.
Posted by: Angela T
I feel they should expand the care of np and pa to help rectify the situation instead of making the matter worse or more expensive healthcare is already barely affordable
Posted by: Judy Z
Posted by: Kimberly J
I think every person in this country should have access to insurance. People die in this country just because they cannot afford healthcare.
Posted by: Octavian C
doctors have to do their jobs that's why they are learning for 20years.OK!
Posted by: Patricia K
As a registered nurse for 38 years and a Nurse Practitioner for 12 years I do feel competent to care for many adult patients, relating to health promotion, disease and medication management as well as diagnosing and treating multiple health issues.  We are an integral member of the health care team and those who are not willing to accept and utilize our skills are only placing a multitude of patients at risk for denial of health care
Posted by: Deborah P
I believe that Nurse Practitioners play a vital role in the healthcare industry; as well as the Physician Assistants. However, I do not agree that Nurse Practitioners should be treated differently than the Physician Assistants. If the Physician Assistants as the name implied is supervised by the licensed Medical Practitioner (MD), this should also apply to the Nurse Practitioners as well.If you give such strong powers to the Nurse Practitioners you are in essence saying they are as well educated as the medical doctors although they are not. You are saying they can made all medical sound decisions without the support of a real physician. What should happen if the NP (Nurse Practitioner provide incorrect information or medicate treatment to a patient and the patient sues? Will the NP be required to acquire their own malpractice insurance without the support of a license physician.As it stands now, there are some barriers in place to prevent NP's from believing they are medical doctors. If you remove these barriers when you have so many licensed organizations such as:American Medical Association (AMA),American Academy of Family Physicians, American Academy of Pediatrics and theAmerican Osteopathic AssociationIf all these verified, licensed agencies believe that NP should be supervisors, I'd say based on their knowledge, experiences and factual data there is a reason. If Obamacare is going to create high risk medical care for consumer, then there is certainly a problem and there could be an increase in patients receiving poor medical advice at the same time.I, for one, have had the experience of a nurse practitioner and for the most part they serve their roles well for non-threatening ailments. However, they are nurses with a Master's Degree and not doctors. Their decision authority should not be at the same level of a doctors.By moving forward with the Nurse Practitioner out of demand for general medical care, and advancing their role you put all of us consumers at a disadvantage and you gradually start minimizing the role of the Medical Doctor (MD). You in essence are sending us back in time where nurses did have such a high role in the medical profession. My question is why were they removed from this role in the first place; and there is data to support that decision as well.Consumer's today want everything fast, but they do not consumer the risk of fast results. Meeting the growing need of more people needed healthcare, but advancing the role of NP is outrageous.
Posted by: Dr. Robert N
Doctors of Chiropractic are licensed physicians in most states and because they receive much of the same training as MD's and DO's are already considered primary care physicians in states such ad Illinois.  Hospitals are already reaching out to many DC's in an effort to bring them on board as well.  With Obamacare putting an emphasis on preventive care and many patients inclinations toward a more natural, conservative approach, DC's are ideally fitted for expanded roles in our healthcare system.
Posted by: Alex Kecskes
David:  Check out my article, Real Financial Aid for Nursing Students at
Posted by: David M
I'm wondering what's going to change in becoming a NURSE?Schooling at this time has gotten to expensive for me to think about & if there is another way to get educated on becoming a NURSE, I'm open to anything to get me there.Thank you
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