The Pluses and Minuses

Asking what works means we also have to ask what doesn't work. The problem is the pluses and minuses are rarely crystal clear.

For example, federally-qualified health centers (FQHC) are wonderful "pluses" in their communities for primary care for the uninsured and under-insured, but are a "minus" in that they have difficulty referring a patient for specialty care because of our current insurance/reimbursement system (or lack thereof).

Another "plus/minus" issue are our various health-care providers. We are fortunate to have many talented and dedicated physicians, advanced practice nurses, nurses and other health care workers in our country, which is a definite plus. However, we need to do a better job of aligning ability with authority. Specifically, in the case of nurse practitioners, they who are master's educated and provide a high level of safe, quality care with protocols and physician collaboration. Nurse practitioners can help improve access to primary care, but often their legal scope of practice is restricted by state medical boards, a minus.

One solution would be to provide more Title VIII of the Public Health Service Act money to educate more nurse practitioners. Another solution would be to redirect the percent of federal Graduate Medical Education (GME) monies that now go to hospital nursing to the support of nurse practitioner training, just as GME supports physician resident training. Leveling this playing field and allowing nurse practitioners in each state to practice to their full scope of practice would be a significant help in addressing the shortage of primary care physicians. In my opinion, we are not going to force MDs to become primary care MDs -- we should direct MDs to specialty care (where there is also a shortage) and leave primary care to nurse practitioners and physician assistants.

By Colleen Conway-Welch  |  July 1, 2009; 1:21 PM ET  | Category:  Health Care Reform
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