Physicians and Nurse Practitioners Respond to National Survey

There is a shortage of primary care physicians in the United States, a situation made more critical in the face of an aging population and an increase in the incidence and prevalence of chronic illnesses. When the provisions of the Patient Protection and Affordable Care Act are implemented in 2014, millions of previously uninsured Americans will have the means to purchase health insurance and gain access to healthcare services.

To address the combination of increased demand and provider shortages, policymakers are examining the possibility of increasing the supply of nurse practitioners and expanding the scope of their responsibilities in primary care.

According to researchers, proposals to expand the role of nurse practitioners have been met with both interest and controversy. The controversy centers on whether nurse practitioners have adequate education and experience to provide high-quality services and lead clinical services without the supervision of a physician.

To “inform the debate about roles of nurse practitioners and physicians in private practice,” researchers recently conducted a national survey focusing on the role of nurse practitioners in primary care and the possible effects on the healthcare system of expanding the supply of nurse practitioners as well as the scope of their responsibilities. They reported survey results in the New England Journal of Medicine [2013;368(20):1898-1906).

The National Survey of Primary Care Nurse Practitioners and Physicians was conducted from November 23, 2011, through April 9, 2012. The postal-mail survey was sent to 467 nurse practitioners and 505 physicians. Eligible survey participants were licensed nurse practitioners or physicians who had been trained in a primary care specialty, were actively working in a primary care practice, and were providing direct patient care.

The questionnaire domains included scope of work, practice characteristics, and attitudes about the effect of expanding the role of nurse practitioners in primary care.

There were significant differences between physicians and nurse practitioners vis-à-vis several personal and clinical-practice characteristics. Nurse practitioners were more likely to be female, be older, have fewer years of professional experience, and less likely to self-identify as a member of racial or ethnic minority. In addition, on average, nurse practitioners worked fewer hours, saw fewer patients, and earned lower incomes compared with physicians. Finally, 80.9% of nurse practitioners reported working with a physician compared with only 41.4% of physicians reporting working with a nurse practitioner.

The majority of nurse practitioners (74.9%) who responded to the survey said they believed they were able to practice “to the full extent of their education and training.” Those who did not feel that way indicated reasons such as state restrictions, hospital regulations, and the type of work setting as the main factors limiting the scope of their practice.

When asked if nurse practitioners should lead medical homes, 17.2% of physicians said yes, compared with 82.2% of nurse practitioners who said yes. When asked about equal pay for the same services, 3.8% of physicians said the pay should be equal compared with 64.3% nurse practitioners.

In responding to questions relating to perceived differences in the quality of care provided by physicians, the responses from the 2 groups were diametrically opposed: 66.1% of responding physicians agreed with the statement “physicians provide a higher quality of examination and consultation” than nurse practitioners do during the same type of primary care visit, compared with 75.3% of nurse practitioners who disagreed.

The survey concluded with a section on the supply of nurse practitioners in the United States. A majority of respondents in both groups said that having more nurse practitioners would result in improved timeliness of care (72.5% of physicians vs 90.5% of nurse practitioners) and improved access to healthcare services (52.2% of physicians vs 80.7% of nurse practitioners).

In conclusion, the researchers commented, “Both physicians and nurse practitioners will be needed to address the many challenges of developing a workforce that is adequate to meet the need for primary care services. It is our hope that the stark contrasts in attitudes that this survey reveals will not further inflame the rhetoric that has been offered by some leaders of the two professions, but rather will contribute to thoughtful solutions for healthcare workforce planning and policy.”