Bracing for Obamacare: Nurse practitioners fill doc shortage gap
DEXTER, Ore. — It’s 8:15 a.m. on a warm July Wednesday and the parade of patients is already lining up for Mary Fey, a family nurse practitioner on the front lines of health reform in this rural community 100 miles south of Portland.
There’s the 32-year-old guy with a Hobo spider bite and high blood pressure, the 61-year-old with a sore shoulder from a tractor accident, the 9-year-old with allergies, the 91-year-old with dementia.
They all come to Fey, the sole primary care provider for nearly 30 miles in this region where doctors are in short supply – and the January launch of Obamacare is expected to make it worse.
“I’m pushing 1,500 patients now and that’s going to increase,” said Fey, 58, who refers to the coming changes as “the onslaught.”
Like nurse practitioners across the U.S., Fey is girding for the onset of reforms put in place by the 2010 Affordable Care Act, which offers some 32 million Americans new access to health insurance — but no guarantee of access to care.
“It will be better, but it’s painful to get to something better,” said Fey.
Experts estimate the U.S. is already short more than 9,000 primary care physicians, a number expected to rise to 65,800 by 2025, according to the Association of American Medical Colleges.
Image by The U.S. Army via Flickr
If newly insured Americans are going to get care under the federal health overhaul, it’s Fey and her colleagues who will have to help fill the gap, analysts say.
‘Huge, huge solution’
“To me, nurse practitioners could be a huge, huge solution to this problem of primary care shortage,” said Dr. Thomas Bodenheimer, a professor of family and community medicine at the University of California, San Francisco, School of Medicine.
NPs, as they’re sometimes known, are registered nurses who hold graduate degrees and can perform virtually all of the functions of front-line family doctors — depending on the laws of the state they’re in.
Debate Over Role of Nurse Practitioners in Primary Care Responsibilities
An estimated 6 million Californians will be eligible for insurance under Obamacare — about 5 million through the Covered California marketplace and more than a million people via the Medi-Cal expansion.
Yet, just 16 of California’s 58 counties have enough primary care doctors right now. To try to improve access, California legislators are moving bills to expand “scope of practice” for such midlevel health providers as pharmacists and nurse practitioners. In general, such bills would allow certain health providers to practice more independently. Right now, in many cases, they must be overseen by physicians. More autonomy could open access for underserved groups.
But some of those ideas are being hotly debated in Sacramento.
The toughest scope-of-practice sell right now seems to be nurse practitioners. Earlier this week,SB 491, which would expand nurse practitioner duties, failed to get out of committee. It will be up for a vote again next week. State Sen. Ed Hernandez (D-West Covina), an optometrist himself, joined KQED Forum Friday to discuss the bill. He said California needs to “utilize providers within their training” to help ease this “huge access problem in primary care.”
California, as it turns out, is among only a handful of states with the most restrictive policies (see map) around nurse practitioners and patient care. Paul Phinney, a pediatrician and president of the California Medical Association, said “allowing nurse practitioners to practice independently fragments care.” He agreed there is tremendous primary care need, but said a better way to address the problem would be to “have physicians and nurse practitioners work collaboratively in teams.”
Bills on nurse practitioners, pharmacists advance in Assembly
SACRAMENTO — Measures that would expand the roles of nurse practitioners and pharmacists advanced in the Assembly on Tuesday, setting the stage for a fierce lobbying battle in the session’s final weeks.
Both measures wade into the so-called scope of practice debate over what type of medical care can be administered by non-physicians, setting off a turf war between doctors and other medical providers.
The more contentious of the two bills is SB 491, which would allow nurse practitioners to practice without physicians’ supervision. The measure, written by state Sen. Ed Hernandez (D-West Covina) failed to muster enough support in the Assembly’s Business, Professions and Consumer Protection Committee last week by a 6-3 vote, with five committee members abstaining.
Hernandez offered a narrower version of the bill Tuesday, which would allow nurse practitioners to operate independently only if they practice at a hospital, clinic or some other medical facilities. That was enough to bring on two additional Assembly Democrats — Richard Gordon of Menlo Park and Chris Holden of Pasadena — and pass with an 8-3 vote.
Hernandez is also the author of SB 493, which would allow pharmacists to independently administer some vaccines, and provide certain nicotine replacement drugs and hormonal contraceptives. It passed the Assembly Health Committee on an 18-0 vote.
Both bills now move to the Assembly Appropriations Committee.
Supporters of the Hernandez bills say that nurse practitioners, pharmacists and other medical providers can help secure healthcare access in places where there are not enough doctors to meet patients’ demand. That strain could be exacerbated with the implementation of President Obama’s healthcare law, which will increase the number of newly insured patients seeking treatment.
“If we are going to be mandating that every single person buy health insurance, then we better make sure that there’s enough people to see these people safely,” said Hernandez, who is head of the Senate Health Committee.
Doctors counter that allowing non-physicians to practice independently could put patients in harm’s way.
Originally posted 2014-06-17 06:15:00. Republished by Blog Post Promoter