Doctor shortage and disparities after reform examined, nurses prepare for changing role

Aug 3 2009

A former Clinton administration official said last week that there aren't enough doctors in America to handle the increase in patients if health reform covers more uninsured, NPR reports.

Donna Shalala, secretary of the Department of Health and Human Services in the Clinton administration, told NPR "'The shortage is related to primary care,' ... 'We have lots of specialists in the country. We'll need more primary care physicians.'"

In addition to cutting costs in Medicare, "Shalala, now president of the University of Miami, says there will be opportunities for nurses to take on a larger role in offering primary care. 'With all the advanced-practice nurses that we have in this country and more to be trained, there is a special role for nurses in our expansion of health care for all,' she says" (Simon, 8/1).

Time reports: "But there is an existing group of providers that health reformers are hoping can help fill this gap: nurse practitioners. Depending on the state in which they practice, nurse practitioners, with advanced training often including master's degrees in nursing, can often treat and diagnose patients, as well as prescribe medication. And they can do these things at a lower cost than doctors — Medicare, for example, reimburses nurse practitioners 80% of what is paid to doctors for the same services. … In addition to providing many of the same services more cheaply, nurse practitioners offer something else that makes them darlings to health reformers: a focus on patient-centered care and preventive medicine. In the recently released House health-reform bill, nurse practitioners (and physician's assistants, another relatively new, but smaller, category of medical professionals who can perform medical procedures and often prescribe medication) are listed alongside doctors as primary-care providers. Nurse practitioners lobbied hard for this legislative language in meetings with White House health officials, including Nancy-Ann DeParle, Obama's health-reform czar" (Pickert, 8/3).

The Associated Press reports that smaller towns in rural America look to nurse practitioners to fill the gap already: "Small towns often lack specialists and rely on family physicians. But even incentives such as covering student debt for new doctors haven't worked. Many small towns look to nurse practitioners for general care or seek foreign doctors using J-1 visa waivers. According to the Washington, D.C.-based National Rural Health Association, only about 10 percent of U.S. physicians practice in rural areas. The problem: Medical students know they can make more money, and work shorter hours, in a specialty practice in a city." For instance, a clinic in rural southern Colorado relies on nurse practitioners for basic exams, but many sick patients get referrals to a larger town half an hour away, The AP reports (Wyatt, 8/2).