In several previous blog postings, I have discussed what I consider to be the two biggest political challenges to rebuilding the primary care workforce capacity in the United States.
One is the risk that medicine will split into a civil war between primary care physicians and other specialties over the issue of "how to pay for it."
The other is that the coalition of advocates for primary care - physicians, nurses and physician assistants - will splinter over each profession's contributions and importance.
Today, the ACP releases a new policy monograph on Nurse Practitioners in Primary Care. The paper makes the case that respectful and true collaboration is in the best interests of both professions and the patients they serve. It defines collaboration as "ongoing interdisciplinary communication regarding the care of individuals and populations of patients in order to promote quality and cost-effective care."
ACP offers principles on collaboration, include recognizing each profession's complimentary roles as defined through their professional practice acts, appropriate sharing of information, and mutual acknowledgment of, and respect for, each professional's knowledge, skills, and contributions.
In developing the paper, ACP met with several highly-regarded nurse practitioners active in their respective professional associations to seek their insight, even on issues where they didn't quite see eye-to-eye with ACP.
The paper does not shy away from controversial issues.
On training and skills, ACP has this to say:
"Physicians and nurse practitioners complete training with different levels of knowledge, skills, and abilities that while not equivalent, are complementary."
"Patients with complex problems, multiple diagnoses, or difficult management challenges typically will be best served by physicians, working with a team of health care professionals that may include nurse practitioners."
On credentials and the doctor of nursing degree:
"Patients should have the right to be informed about the credentials of the person providing their care to help them distinguish among different health care professionals."
On the Patient-Centered Medical Home:
"Patients are best served by a multidisciplinary team led by a physician" although PCMH demonstration projects could also test the effectiveness of nurse practitioner-led PCMH practices operating within state scope of practice acts and meeting the same eligibility standards as physician practices.
On how many NPs and primary care physicians are needed to meet the growing shortage of primary care clinicians for adults:
"Training more nurse practitioners does not eliminate the need nor substitute for increasing the numbers of general internists and family physicians trained to provide primary care" and "workforce policies should ensure adequate supplies of [both] primary care physicians and nurse practitioners."
Although the focus of this new paper is on the role of NPs in primary care, ACP also recognizes the essential role that physician assistants play as members of the primary care team. The role of PAs in primary care will be the subject of a future policy paper, to be developed with input by respected members of their profession.
As an evidence-based document that reflects consensus, ACP's paper will likely disappoint the more extreme voices within each profession.
NPs who claim that they can replace primary care doctors will take issue with ACP's conclusion that the U.S. need more primary care physicians and NPs. They likely will disagree with ACP's view that patients with multiple chronic illnesses are typically best served by a team led by a primary care physician.
Primary care physicians who insist that the only acceptable practice model is one in which NPs work for them will likely take issue with ACP's emphasis on collaborative models of care that involve "mutual acknowledgment of, and respect for, each professional's knowledge, skills, and contributions."
The issue in my mind really shouldn't be about which profession works for the other. Rather, it is making sure that all members of the health care team are working as effectively as they can for patients.
Developing more effective models of collaboration between physicians and nurses not only makes for good health policy, it also makes for good politics.
Today's questions: Do you agree with ACP's views on the role of NPs in primary care and its emphasis on promoting collaborative models of care?