After finishing the most recent Freakonomics podcast on Nurse Practitioners (NPs) filling the workforce shortage in primary health care, I was disheartened by the negative sentiment prevalent in the comments. If you haven’t heard the episode yet, you can listen to it here.
As a nurse and Midwife with nearly 40 years of experience, I have worked in a variety of practice settings and have seen firsthand how a lack of understanding between healthcare professionals can lead to worse outcomes for patients and lower quality of life for providers.
I have also seen how, by working together, nurses, Midwives, and physicians can create practice models that lead to more positive outcomes, lower costs for patients and hospitals, and maximize high-net billable hours for physicians. Additionally, states that have moved to full practice authority have shown increased health care access without negative effects on physicians. None of these states have reversed their position on Advanced Practice Registered Nurses. The positive effect on veteran’s health is particularly noticeable.
Sounds like an economist’s dream, right? It’s for this reason that we must quell the hysteria surrounding NPs practicing to the fullest scope of their education and training.
There is no doubt, as the American Medical Association recently identified, the health care provider shortage is rapidly worsening, with a projected physician shortfall between 2015-2030 of 104,900 physicians.
Reading the post-airing comments, you’d think the podcast advocated for physicians to be replaced with unlicensed, untrained, amateur healthcare providers. The addition of NPs to the health care team is not to replace the role of others, but to assist in and augment gaps in service wherever they exist.
Two recurring themes caught my attention within listener comments: perceived lack of competence on the part of NPs to provide primary care and the lack of attention paid to the reputable, longitudinal data surrounding health outcomes with the involvement of NPs.
My entire career has been spent in maternity care and I can tell you that the worsening workforce projections seen in primary care are happening in women’s healthcare too. The American College of Obstetrician and Gynecologists (ACOG) has been vocal on this issue for years.
Many issues are contributing to the shortage:
- Few OB/GYNs want to work in rural America
- 24/7 call rotations cause quality of life issues
- High premiums for malpractice insurance influence the type of specialty medical students consider when selecting residency pathway.
When it comes to women’s health care, Midwives are a very viable resource for closing the provider shortage gap. Data surrounding outcomes for childbearing women cared for by Midwives has been globally recognized and more recently noted in a Cochrane review.
Certified Nurse-Midwives (CNMs) are licensed, independent health care providers with prescriptive authority in all 50 states, the District of Columbia, American Samoa, Guam, and Puerto Rico. CNMs are defined as primary care providers under federal law. Certified Midwives (CMs) are also licensed, independent health care providers who have completed the same midwifery education as CNMs. CMs are authorized to practice in Delaware, Missouri, New Jersey, New York, and Rhode Island. CMs have prescriptive authority in New York and Rhode Island. The CM credential is not yet recognized in all states.
What do physicians think about Midwives helping fill the gap? Dating back to 2011, ACOG has stated that CNM/CMs are experts in their fields of practice, and are educated, trained, and licensed, independent providers who may collaborate with each other based on the needs of their patients.
In 2016 ACOG led a multidisciplinary workgroup that authored a 60-page guide on implementing team-based care, endorsed by more than 20 national health care organizations. Its aim is to address the changing and increasingly complex health care delivery system.
By working within a care team that holds each role as mutually valuable, the scope and role of all health care providers can be maximized. This model reduces the cost of care, while improving the quality and efficiency of healthcare delivery, particularly as it relates to the current workforce shortage.
Organizations like the AMA, ANA, and other specialty groups must find ways to dialogue together, to address how collaborative models of team-based care can be implemented without restrictive supervisory language across all states. Nearly ½ of the states have already adopted laws providing full practice authority for NPs. We are working aggressively to expand all Midwifery credentials as well. This can go a long way toward addressing the shortage of women’s healthcare providers in the US.
It is clear we will not have enough physicians to meet demand using the current framework of educating physicians. Educating NPs and CNM/CMs is much less costly and takes less time than educating doctors and the outcomes are equally positive when services focus on essentially healthy populations. ACOG and ACNM work closely to build partnerships in care that positively address demand and need in promoting team-based care.
Health care providers can do better than fight among themselves for types for control, money, and status, and we should. If you’re ready to learn how, watch our webinar from Thursday, November 30th @ Noon, EST where we discussed pearls on how to navigate conversations toward independent practice.