ROLE10good.pdf - The n e w e ng l a n d j o u r na l of m e...

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special article T h e ne w engl a nd jour na l o f medicine n engl j med 368;20 nejm.org may 16 , 2013 1898 Perspectives of Physicians and Nurse Practitioners on Primary Care Practice Karen Donelan, Sc.D., Catherine M. DesRoches, Dr.P.H., Robert S. Dittus, M.D., M.P.H., and Peter Buerhaus, R.N., Ph.D. From Mongan Institute for Health Policy, Massachusetts General Hospital, and Harvard Medical School — both in Bos- ton (K.D.); Mathematica Policy Research, Cambridge, MA (C.M.D.); and the De- partment of Medicine, Institute for Medi- cine and Public Health, Vanderbilt Uni- versity, and VA Tennessee Valley Geriatric Research, Education, and Clinical Center (R.S.D.), and the Center for Interdisciplin- ary Health Workforce Studies, Vanderbilt University Medical Center (P.B.) — all in Nashville. Address reprint requests to Dr. Donelan at Mongan Institute for Health Policy, Massachusetts General Hospital, 50 Staniford St., 9th Fl., Boston, MA 02114, or at [email protected] N Engl J Med 2013;368:1898-906. DOI: 10.1056/NEJMsa1212938 Copyright © 2013 Massachusetts Medical Society. Abstr act Background The U.S. health care system is at a critical juncture in health care workforce plan- ning. The nation has a shortage of primary care physicians. Policy analysts have proposed expanding the supply and scope of practice of nurse practitioners to address increased demand for primary care providers. These proposals are controversial. Methods From November 23, 2011, to April 9, 2012, we conducted a national postal-mail survey of 972 clinicians (505 physicians and 467 nurse practitioners) in primary care practice. Questionnaire domains included scope of work, practice characteris- tics, and attitudes about the effect of expanding the role of nurse practitioners in primary care. The response rate was 61.2%. Results Physicians reported working longer hours, seeing more patients, and earning high- er incomes than did nurse practitioners. A total of 80.9 % of nurse practitioners reported working in a practice with a physician, as compared with 41.4% of physi- cians who reported working with a nurse practitioner. Nurse practitioners were more likely than physicians to believe that they should lead medical homes, be al- lowed hospital admitting privileges, and be paid equally for the same clinical ser- vices. When asked whether they agreed with the statement that physicians provide a higher-quality examination and consultation than do nurse practitioners during the same type of primary care visit, 66.1% of physicians agreed and 75.3% of nurse practitioners disagreed. Conclusions Current policy recommendations that are aimed at expanding the supply and scope of practice of primary care nurse practitioners are controversial. Physicians and nurse practitioners do not agree about their respective roles in the delivery of pri- mary care. (Funded by the Gordon and Betty Moore Foundation and others.) The New England Journal of Medicine Downloaded from nejm.org on March 10, 2017. For personal use only. No other uses without permission.
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