Primary care physicians, nurses hold widely different views of NPs' quality of care

A new study published in the New England Journal of Medicine shows that doctors and nurses hold vastly divergent views on the quality of care that NPs provide, whether NPs should lead medical homes and whether physicians and NPs should be paid the same amount for providing the same services.

With the United States staring down a shortage of primary care physicians, one obvious way of relieving that shortage could be to allow nurse practitioners to play a greater role in providing primary care.

If only it were that simple.

A new study published in the New England Journal of Medicine revealed how difficult it's likely to be to significantly expand nurse practioners' (NPs') scope of practice. The study, which was led by a Harvard School of Medicine assistant professor, shows that doctors and nurses hold vastly divergent views on the quality of care that NPs provide, whether NPs should lead medical homes, and whether physicians and NPs should be paid the same amount for providing the same services.

"This kind of inter-professional disagreement is not a good thing when we’re trying to achieve better teamwork,” lead author Karen Donelan, ScD, told Kaiser Health News.

Survey data from the study tell the story. For example:

66% of physicians said physicians provider "higher quality of examination and consultation" than NPs, whereas just 25% of NPs agreed.

17% of physicians think NPs should lead medical homes, whereas 82% of NPs think they should.

4% of physicians think NPs should be paid equally for providing the same services, compared with 64% of NPs who thought so.

That NPs and physicians would hold different views about what NPs' role should be in healthcare is not exactly surprising. Physicians groups such as the American Academy of Family Physicians have consistently opposed measures that would broaden NPs' scope of practice.

What is surprisin-to the study's lead author, at least-is the extent to which physicians and NPs disagree on the matter. "We’ve done a lot of comparative surveys with health professionals, but we’ve just never found gaps this big," Donelan says.

The study's authors acknowledged that several reasons exist for "polarized views" between doctors and NPs, such as different cultures of professional education, differences in the "scope and duration" of their training, and different processes for licensure and credentialing.

The authors end the study with a Rodney King-like "Can-we-all-get-along?" plea.

"It is our hope that the stark contrasts in attitudes that this survey reveals will not further inflame the rhetoric that has been offered by some leaders of the two professions but rather will contribute to thoughtful solutions for health care workforce planning and policy," the study concludes.

Good luck with that.

The survey was taken by 972 clinicians - 467 NPs and 505 physicians.

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