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Doctors and NPs sharply divided over scope of practice

NEWS IN BRIEF — Posted May 27, 2013

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Physicians and nurse practitioners are split over the role NPs should play in boosting the supply of primary care, said a study in the May 16 issue of The New England Journal of Medicine that reported the results of a survey of 505 doctors and 467 NPs practicing in primary care settings.

Although an influential 2010 Institute of Medicine report called for expanding the legally allowed scope of practice for NPs and advanced-practice nurses to help avert primary care shortages, a majority of the physicians surveyed were skeptical that boosting the supply of NPs would improve the safety, effectiveness, cost-effectiveness or patient-centeredness of primary care. Nearly three-quarters of physicians agreed that more NPs would improve the timeliness of primary care and access to care for uninsured patients, said the study (link).

But while 82% of NPs thought they should lead medical homes, only 17% of doctors thought so. Only 25% of NPs thought doctors delivered a “higher quality of examination and consultation” than they did, and 66% of physicians agreed with that claim.

Meanwhile, 82% of NPs said they should get the same pay for providing the same clinical services as physicians. Just 17% of doctors agreed with that idea. There also was a huge gap in the two groups’ views on whether NPs should be legally allowed hospital admitting privileges.

“Our survey results support calls for increased innovation in interprofessional education of the primary care work force, encompassing curriculum content, training and demonstration of competence,” the study’s authors wrote.

The American Medical Association has policy supporting a physician-led, team-based approach to care.

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