Are NPs and Physicians Interchangeable?

With the looming physician shortage not expected to go away, the health care industry is trying to find a way to fill the gaps. However, there is some disagreement about the best way to do so.

A recent Health Affairs study revealed that although Americans prefer a physician to be their primary care provider, they would be willing to see a nurse practitioner (NP) or physician assistant (PA) instead if it meant getting help sooner.

“We need to focus on building our capacity to train physicians, while also embracing the roles in which other professionals can serve,” Darrell G. Kirch, MD, president and chief executive officer of the Association of American Medical Colleges, said in a statement in early June.

Reid Blackwelder, MD, president-elect for the American Academy of Family Physicians (AAFP), has taken the stance that physicians and NPs are not interchangeable — something AAFP has said in the past.

“This is not about turf, or better/worse, or good/bad,” Blackwelder wrote in an AAFP blog post. “It is about teams, which also include physician assistants, who have not been a routine part of the scope of practice conversation. We must create and implement efficient physician-led teams to meet the triple aim of better patient outcomes, improving the health of our patients and lower costs.”

However, the American Association of Nurse Practitioners (AANP) has, understandably, taken the opposing side of the argument. Both AANP and AAFP debated their sides of the argument in The Wall Street Journal last week.

“Nurse practitioners already treat patients without physician oversight in about a third of all states, the majority of which have allowed it for nearly 20 years,” Angela Golden, president of the AANP, wrote in Journal.

Golden argues that NPs spend more time with patients than physicians and studies find patients who receive primary care from NPs report being equally or more satisfied as patients treated by physicians.

“The reality is, nurse practitioners make referrals to specialists in the exact same manner as primary-care physicians,” she wrote in the Journal. “We must focus on the well-being of patients rather than on turf protection. This means closing the gap between what nurse practitioners are educated and trained to do, and what they are legally permitted to do.”

Joy Elwell, a director for AANP, wrote in The Buffalo News that the rigorous training NPs go through equips them to provide high-quality, safe, autonomous care. Furthermore, NPs are more likely to stay in primary care, she wrote.

Blackwelder argues that while NPs have a vital role to play, they are not physicians. In fact, he wrote in his essay for the Journal that states allowing independent practice of NPs are “part of our broken national health-care system.”

However, he says that in team-based care family physicians, NPs and PAs would be working together to meet the health needs of American patients. Each member of that team would bring his or her own education, training and experience.

“Although some tasks and services can be shared, the roles each of us play are not interchangeable,” he wrote in his blog post. “The medical expertise of primary care physicians must be a part of the team-based care patients need and deserve.”