Letter: Use APRNs to solve primary care shortage

In his timely article, “Solving the crisis in primary care” in the August 25 issue, Stephen C. Schimpff, MD, offers several ways to resolve the deficiencies of the primary care system: too few primary care doctors and not enough time to see patients and build a trusting relationship being the most pressing issues.

It takes about 11 years to train a primary care doctor. I don’t think that the system can train enough of them over the next several years (taking into account the added influx from the Affordable Care Act) to adequately supply the future need.

I think that advanced nurse practitioners [APRNs] will have to be recruited to help solve the problem. They are already independently licensed in at least 20 states. Either working alone or in collaboration they hold great promise to provide the projected need of primary care services that is soon to appear.

Ideally direct pay is a good idea but ironically it will only worsen the shortage because most patients will balk at the idea of paying yearly membership fees in addition to insurance premiums.

Finally, being available 24/7 will require herculean energy and stamina and the sacrifice of personal time. Primary care doctors are already overstressed and either burned out or approaching it. The availability that Dr. Schimpff desires will only accelerate burnout and leave little time for personal development.

The conclusion? Use APRNs to help solve the primary care crisis. It may not be the complete answer but it is a big part of the answer.

Edward Volpintesta, MD

 Bethel, Connecticut