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The Importance of Nurse Practitioners in Health Care Reform

There are approximately 50 million uninsured Americans. As the Affordable Healthcare Act goes into effect over the next several years, many of those people will qualify for coverage. It's predicted that nearly 30 million people in the United States will be looking for healthcare providers within the next two years. California alone is expected to have almost 7 million people seeking doctors. It is likely that primary care physicians will not be able to cope with this surge in patients. The number of primary care physicians has been declining for years as doctors choose to pursue higher paying specialties. This shortage is already being felt nationwide and an increased demand is going to exacerbate this problem. Particularly strained regions may face the possibility of long waiting periods and lowered standards of care.

The solution to this looming problem may lay with nurse practitioners and nurse practitioner run clinics. Nurse practitioners are trained to provide comprehensive primary medical care. They are trained to handle preventative and acute healthcare needs including: conducting physicals, reading lab results and X-rays, prescribing medication, and diagnosing a variety of health concerns. Nurse practitioners have completed post-graduate degrees and are registered nurses. Not only can they provide the same primary healthcare as physicians, there is an increasing number of nurse practitioners. Federal employment statistics show that there were over 160,000 nurse practitioners as of 2008, and the field continues to grow.

Nurse practitioner-run clinics provide a promising outlook for utilizing nurse practitioners to meet primary care demands in undeserved communities. These clinics offer affordable comprehensive primary care services. There are nearly 300 such clinics operating across the country. Currently, about 20 of these clinics receive funds from a special government program to provide affordable care in such communities. Studies show that these clinics improve community health, provide a high standard of care, and result in high levels of patient satisfaction. A 2009 Rand Corporation report found that nurse practitioners provide care equivalent to primary care physicians and exceed physicians in promoting health services and education. These clinics also save taxpayer dollars. Not only are nurse practitioner salaries lower than physicians', their availability in low income communities reduce reliance on emergency room visits. Those without comprehensive healthcare options have historically used costly emergency room services for non-emergency healthcare needs. This becomes less necessary as the acute healthcare services offered by these clinics provide an affordable alternative.

One such clinic is GLIDE Health Services in the Tenderloin district of San Francisco. This clinic is staffed by nurse practitioners and specialists. It meets the majority of medical needs for over 3,000 people in the community. It provides primary and preventive care, mental health services, and HIV testing. They serve a community that deals with the health problems resulting from substance abuse and poverty. Despite these challenges, this clinic sees results comparable to physician-based comprehensive care. They connect well with their community and find that patients follow through with their recommended treatment and checkups for chronic conditions like diabetes.

Nurse-practitioner clinics provide an efficient and affordable model of care, particularly during this transitional period of healthcare reform. A recent report entitled "The Future of Nursing" issued by Institute of Medicine, of the National Academy of Sciences, called for nurse to be full partners with physicians in redesigning U.S. healthcare. These clinics show that nurse-practitioners are ready to heed that call, but there are still major obstacles to expanding nurse practitioner-run primary care services. Medicare, Medi-Cal, and California-based programs to provide coverage for the uninsured have contracted with nurse-practitioners for primary care services. Despite this, real expansion of nurse practitioner as primary care providers is being limited by large private health plan companies. These managed care organizations are reticent to contract with nurse practitioners. Despite nurse-practitioners' qualifications and proven success providing primary care services equivalent to physicians, these companies require physician supervision for billed nurse-practitioner services. A study by the National Nursing Centers Consortium established about half of such companies maintain this stance.

Properly utilizing nurse-practitioners will help ensure patients have quality access to primary care providers and amending state insurance codes is the first step toward that goal. For example, California currently only requires these private insurance companies contract nurse practitioners as primary care providers in cases involving Medicare and Medi-Cal. Changing this to encompass all coverage would help remove the obstacles facing nurse practitioner-based care. This, and other such reforms, would greatly improve rates for access to primary care providers.