Physicians, It is Time to Manage Care Delivery

Bloomberg posted an article on Christy Blanco, a Ph.D. nurse practitioner, whose El Paso, Texas, clinic has a long waiting list of patients, and sits empty because Texas law requires a physician to supervise her work. She can’t find one.

Across the border in New Mexico, where the law has no such requirements, nurse practitioners’ clinics are full. They care for people suffering from depression to diabetes, freeing physicians to treat more complex disorders.

So long as there are people without access to quality health care, and so long as NP's are viewed as a lower cost alternative to primary care physicians, there will be increasing pressure to allow NP’s licensure to provide for the gap in access without physician supervision.

The American Association of Family Physicians needs to heed the advice of Thomas Paine, the author of “Common Sense,” who influenced the first American Revolution, and to lead, follow, or get out of the way in the healthcare revolution.

Embracing mid-level providers as the work horses of new primary care delivery models (i.e. PCMH) and using them to the fullest as service providers allows physicians and NP’s to practice at the top of their licenses. Nurses are much more compliant with guidelines and protocols used to provide evidence based care than most physicians are. In many cases, they are more empathetic to their patients’ social and emotional barriers to care as well, making them better suited for day-to-day care and to engage patients. 

Captains don't swab the decks, or manage the dock lines. They plot the course. Physicians need to be leaders in their practices, setting the goals and expectations, establishing the protocols and guidelines, monitoring the outcomes and the performance of their teams, and developing workable strategies and interventions to improve the health of the population of patients they manage. Their focus is best applied to manage the most clinically complex patients on their panels. Delivering day-to-day services can and should be done by mid-level providers.

Many nurse practitioners would be better served to work in collaboration with friendly physicians as part of a highly functional care team to avoid the hassles of independent practice and fee schedule pressures currently facing small primary care practices.

Primary-care physicians should be embracing NPs as allies rather than as competitors. This can only happen if physicians change their view of their role in the healthcare system from service providers to population health managers.