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Role Play

Proposed changes to caregiver responsibilities spur debate

Increasing demand for primary care services, paired with a dwindling supply of primary care physicians in the United States, has some health policy experts calling for more nurse practitioners with greater responsibilities.

In 2010 an Institute of Medicine (IOM) committee recommended that nurse practitioners be allowed to admit patients to hospitals and hospices, lead medical teams and medical homes, and receive reimbursements similar to those physicians receive for providing the same services.

A study published May 16 in the New England Journal of Medicine finds, however, that primary care physicians and nurse practitioners significantly disagree on some of the proposed changes to the scope of nurse practitioners’ responsibilities.

“We were surprised by the level of disagreement,” says Karen Donelan, an HMS assistant professor of medicine at the Mongan Institute for Health Policy at Massachusetts General Hospital and the report’s lead author. “We had hypothesized that, since primary care physicians and nurse practitioners had been working together for many years, that collaboration would lead to more common views about their roles in clinical practice. The data reveal disagreements that need to be resolved for teams to function effectively.”

Although debates on the appropriate roles of health professionals are nothing new, the authors note that little data have been available on the roles played by nurse practitioners in primary care and how those roles differ from those of primary care physicians. The survey was mailed to a national random sample of nearly 2,000 primary care clinicians—evenly divided between nurse practitioners and physicians—and responses were received from 467 nurse practitioners and 505 physicians.

A majority in each group agreed with the IOM’s recommendation that nurse practitioners “be able to practice to the full extent of their education and training.” Another point of agreement was that more primary care nurse practitioners were needed to improve access to care.

However, significant disagreement was reported on specific recommendations, including: 82 percent of nurse practitioners believe they should be able to lead medical homes, while 17 percent of physicians agreed; 64 percent of nurse practitioners agree they should be paid equally for providing the same services, compared with 4 percent of physicians; and 60 percent of nurse practitioners in collaborative practices indicate that they provide services to complex patients with multiple conditions, but only 23 percent of physicians in such practices thought those services were provided by nurse practitioners.


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