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Will Your Next Doctor be a Nurse?

February 15

The next time you call for an appointment at your doctor's office, you may be asked if you specifically want to see the physician or if an appointment with the nurse practitioner would be acceptable. This is occurring more and more as lengthy delays to get an appointment often mean unnecessary delays in care. The question being discussed in many circles, "can the nurse practitioner fill in the gaps left by the physician/resident shortage?" Since the passage of the Patient Protection and Affordable Health Care Act, it becomes even more important for national leaders to focus on the efficiencies and effectiveness of care delivery. The shortage of primary care physicians coupled with the limitation on resident work hours has left patients in need of health care professionals that can do the job efficiently, both in time and cost.

Times have certainly changed and recruiters are talking about their increase in openings for advanced practice nurses (APRNs). These nurses include Clinical Nurse Specialists (CNSs), Nurse Anesthetists (CRNAs), Nurse Practitioners (NPs) and Certified Nurse-Midwives (CNMs). A recent survey indicated that patients often chose nurse practitioners (NPs) over physicians when access and responsiveness were being rated. NPs tend to be available and they listen to patients and address their needs. The bottom line is that patients like the care they receive from NPs as much as they do from their physicians.

With advanced clinical and didactic education, the skills and knowledge of this group of professionals can definitely expand the availability of health care to the population. Their scope of practice is mandated by legislation and specific professional regulation and allows for reimbursement from insurance, referrals, prescribing and admitting privileges to health care facilities. The roles of a nurse practitioner and a physician assistant are often misunderstood, as their roles are very similar and both are Master's prepared. A physician assistant is always a subordinate to a physician while a nurse practitioner is an independent practitioner.

In assimilating parts of health care reform, it is evident that the knowledge about the talents of these advanced practice professionals is rapidly increasing. Some examples of this from the Patient Protection and Affordable Health Care Act include Section 5208 that establishes nurse-managed centers. Advanced practice nurses will operate these -centers and they will provide both wellness services and comprehensive primary care, chiefly in underserved or vulnerable populations.

Section 5509 will appropriate funds for education to train advanced practice nurses for all care necessary for the Medicare-eligible population. Five hospitals will receive this funding to establish a graduate nurse education demonstration program in Medicare for FY2012-FY2015. Section 3114 increases the reimbursement rate for CNMs from 65% of the physician rate to the full rate as of 1/1/11. Section 5305 provides grants to APRNs that will agree to practice in the field of geriatrics, long-term care or chronic care management for five years. Although these are just a few of the components in the health care reform structure, it is clear that advanced practice nurses are seen as the backbone of the future.

Data from the U.S. Department of Health and Human Services shows a growth in RNs with a master's or doctoral degree rising 46.9% between 2000 and 2008. Those with the increased degree strictly in a nursing related field during the same time period was 64.4%. The American Association of Colleges of Nursing reports the number of doctoral programs in nursing practice grew from 20 in 2006 to 120 in 2009. The demand continues to increase and 28 new programs opened in 2009 with 161 additional ones in the planning stages.

What this means to the recruitment world is that these positions will continue to increase; college recruitment will be a focus and all other recruitment tools in a recruiter's toolkit will need to be tweaked to focus on this hard-to-fill area. As a consumer, it will mean a change in the health care delivery system and an openness to embrace additional health care professionals that will add both efficiency and a better ROI for care delivery.

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