APRNs fill void

As the shortage of primary care doctors in the United States continues to grow, the industry looks for practitioners to fill the gap.

Thad Wilson, the associate dean of the nursing program at the University of Missouri-Kansas City, said there are 193 physicians for every 100,000 people. He estimates that a suitable number would be around 250, and said that some countries outside the U.S. get up to 300 primary care providers per every 100,000 people.

If health care reform is adopted, it is possible many people who have not had insurance in the past will have access to health care and further widen that gap.

Advanced practice registered nurses help fill that void.

Nurse practitioners are often able to spend more time with patients. Nurse practitioners have a less intensive training and therefore it takes less time to train an advanced practice nurse than a physician.

“Nurse practitioners work in a variety of settings and with a variety of patient populations and can expand the health care delivery capability of primary care,” said Diane Ebbert, Phd, CFNP, director of the advanced practice program at the University of Kansas School of Nursing. “I do think that increased utilization of nurse practitioners is one solution to help with the increasing shortage of primary care physicians.”

The advanced practice program takes anywhere from one and a half years to three or four years, depending on if the nurse goes full or part time.

All nurses that undergo the advanced training are already registered nurses. Most take the program part time and continue to work full time.

Nurse practitioners do not replace doctors. They work collaboratively with a physician but often operate fairly independently.

Ebbert said that nurse practitioners are trained to focus on disease prevention and look at the whole person, while physicians are trained to look for ways to treat and cure diseases.

“I don’t think nurse practitioners are going to replace primary care physicians,” Ebbert said.

Every state has different regulations regarding what nurse practitioners can and cannot do, especially regarding prescriptions of narcotics and review of charts.

In Missouri, a physician must be within 30 miles of a nurse practitioner, and the state mandates a written collaboration between the two. The doctor must be reachable by phone.

The rules are not quite as strict in Kansas. There is a mandated collaboration, but nurse practitioners can generally work more autonomously. For example, Kansas nurse practitioners have more leeway in prescribing narcotic drugs.

UMKC and The University of Kansas will graduate around 130 new nurse practitioners this year. Last year, around 8,000 new nurse practitioners started practicing around the nation. There are around 125,000 nurse practitioners in the U.S. today.

Medical students often choose to specialize in fields that provide more money and better hours, which contributes to the shortage in family practice doctors. Wilson estimated that only seven percent of medical students pick primary care as their residency. He said that, to make up the difference and bring the level of primary care to where it needs to be, around 40 percent of medical students need to choose primary care.

Doctors are registered with the American Medical Association and given a number that tracks them wherever they practice. There is no such national database for nurse practitioners, so they must deal with each state’s board of nursing. This can be hard in the Kansas City area, since both nursing schools are so close to the border, and both states have such different regulations.

Wilson said that there are several programs working on the national level to increase the number of primary care providers in the U.S. He said that barriers must be removed to make it easier for nurse practitioners to practice.

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