As a pediatrician who has worked closely with excellent nurse practitioners and physician assistants for the past 24 years and who has spent his 39 years of practice in rural Eastern North Carolina, I must respond to Deborah C. Varnam’s March 11 Point of View “Autonomy for nurse practitioners.”
It would be unwise for our state to allow nurse practitioners to practice independently. Nurse practitioners should work under the supervision of licensed physicians in what the American Medical Association calls “physician-led teams.”
Many patients enter primary care medical practices every day who require hospital care. Physicians spend four years after college in hospital-based educational programs in medical school. After medical school, physicians spend three to seven years in hospital-based residency training. Physicians, during their extended education, learn to take care of the sickest of the sick patients.
Nurse practitioners, on the other hand, are registered nurses who spend two years enrolled in classroom and outpatient preceptorship work after the usual two-year nursing school experience. I have been a preceptor for nurse practitioner students for most of my career. Nurse practitioners do not spend any of their postgraduate education in a hospital setting learning how to take care of really sick patients.
Americans deserve access to the most highly educated health care professionals. I work with 13 nurse practitioners and physician assistants in our large pediatric practice. I know that my patients will be in good hands when they receive care from these non-physician providers. But I also know that I am responsible for all our patients, and that if the non-physician providers are not comfortable with the degree of illness of the patients, they can immediately obtain help from a physician who works in our practice.
When a health professional opens a primary care practice, there is no way to know whether really sick people will show up asking for care. Nurse practitioners do not have the training to assure that really sick patients receive the care they need. Therefore, nurse practitioners should practice as members of physician-led teams.
Varnam is correct in her assessment of the shortage of physicians in our state and country. However, this shortage is more of a maldistribution, since we have plenty of doctors in our metropolitan communities but major shortages in the rural areas. She is incorrect in stating that nurse practitioners could solve the maldistribution problem if all states would allow independent practice by nurse practitioners. Nurse practitioners tend to practice in the same geographic areas where physicians practice.
It would be possible to solve the maldistribution problem if the state would fund physician-led teams in those geographic areas where there are shortages. Academic centers and tertiary hospitals in those areas may be able to work with the state to assure there are physician-led teams in all of the provider-shortage areas.
David T. Tayloe Jr., M.D., FAAP
The length limit was waived to permit a fuller response to the Point of View.