Empowering nurse practitioners


The Affordable Care Act is expected to add 32 million Americans to health insurance rolls over the next ten years. As a result, demand for medical services is going to increase. The problem is that the increase corresponds with a decrease in the number of primary care physicians, according to the Washington Post.

This should not be a surprise to anyone in Minnesota, the shortage of doctors in rural areas has always been a problem and is likely to be exacerbated without more ways to increase the supply of primary care providers.

Seeing an opportunity, the American Academy of Nurse Practitioners is launching an awareness campaign to elevate the work of its 155,000 members. And it is not going to be easy. Polls show that while most Americans report seeing a NP, few realize how qualified they are. Which is unfortunate because, according to a 2010 Health Affairs article, there is “a growing body of rigorous evidence [that] demonstrates NPs’ important contributions to high-value primary care.”

Furthermore, a different 2010 study compared patient outcome rates for procedures conducted with a nurse anesthetists versus one supervised by an Anesthesiologist and they concluded: “Despite the shift to more anesthetics performed by nurse anesthetists, no increase in adverse outcomes was found … In fact, declining mortality was the norm.”

The AANP plans to follow up their media-blitz with state-lobbying efforts to fight “scope-of-practice” laws that restrain where and how NPs can practice. While Minnesota does not have laws requiring a supervisory relationship with a physician, it does require a collaborative agreement with a physician to write perceptions. These laws are not unique to Minnesota and according to one study, “This wide variation also suggests that regulations for NP practice are not evidence based, have no patient-safety foundation, and appear arbitrary.” 

A 2005 survey (abstract only) of rural nurse practitioners in Minnesota highlights five major barriers: lack of public knowledge of NP’s role, lack of understanding from other health professionals, lower salaries than other nurse professionals, limited space, and lack of a peer network.

Hopefully the AANPs PR push will better inform the public and their colleagues about the important role NPs can play in primary care. The salary question is a bit tricky, but once people better understand NPs they will likely value them more and pay them accordingly. Space concerns could be addressed by clinics and hospitals by providing designated examination rooms and office space. While concerns regarding peer networks have been declining in recent years, rural providers could utilize programs like Skype to communicate.  By working to rectify these problems, we can better use NPs to address the doctor shortage in rural Minnesota.

Minnesota needs a revolution in primary care, something that allows us to dramatically shift the balance, and drive more primary care practitioners to rural areas. Increasing the number of doctors is not necessarily the answer. Instead, we should turn to nurse practitioners as a way to address the primary care shortfall in rural areas. Not only are they qualified, but, as Monica Nauman and the Open Door Health Center show, they are willing to go the extra mile to be more involved in community health.