Obamacare Means Expanded Roles for Nurse Practitioners

Alex Kecskes
Posted by in Companies •
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.

Image courtesy of imagerymajestic / FreeDigitalPhotos.net
Shannon E. Whitten NP-C
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.
Cindy P
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?  
Ricardo P
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.
Michelle L
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.
ANNETTE G
ANNETTE G
I THINK  THE  MD'S AND THE PHD'S ARE  OVER  CHARGING  INSURANCE  COMPANIES . I KNOW  YOU  HAVE  To  LIVE  AND  SO DO WE AND  IF THIS  IS GOING  To  DECREASE  INSURANCE  WHY NOT  NPS ANDPRN ARE  FINE TO ME. TO BE HONEST A MIDWIFE  DELIVERED ME AND  MANY OF YOU AND YOU ARE HEALTHY SO YOU ALL ARE COMPLAINING  CAUSE EDUCATION HAS ADVANCED . PEOPLE  CHANGE ALWAYS HAS PROS AND CONS. LET US GIVE IT A CHANCE AND THE LET US FREELY GIVE  OUR THOUGHT. THIS  IS 4HE LAND OF THE FREE AND EQUAL RIGHTS. THE  OTHER  PRESIDENTS HAVE  MADE  CHANGES  WE THOUGHT  WERE  WRONG  BUT  IT WAS A GOOD CHOICE  THAT'S  WHY THEY  ARE  CALLED  PRESIDENT OF THE US. PEOPL LET'S SPEND MORE TIME BEING OPEN MINDED AND NOT CLOSE MINDED
Rosalio M
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..
Monica_d
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.
Betty D
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?
Alex Kecskes
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)http://www.aanp.org/membership   
Tim R
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.
David Y
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.   
David Y
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.
Annie W
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.
Gayle B
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!!!  
Connie E
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!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Glory A
Glory A
i belive expanding the nurse practictioner to treat patients will help a great deal in the healthcare industry.
Kim W
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.
Tim E
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.
Joseph C
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.   
Margaret S
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.
Margaret M
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.
Rocio R
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.
Joe A
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.
REGINA P
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
Paul  T
Paul  T
It`s a good ideal. As anX navy corpsman,I worked.with patients  sholders in the.Dispensary.We treated.them.as 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.              

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