This story is from the archives of UCLA Today, a discontinued publication.

Nurse practitioners offer the best cure for America's physician shortage

Courtney H. Lyder is the dean of the UCLA School of Nursing, a professor of medicine and public health, executive director of the UCLA Health System Patient Safety Institute and assistant director of the UCLA Health System.
There are more than 155,000 nurse practitioners in the United States who provide high-quality, cost-effective primary care to patients. As America confronts a growing shortage of primary care physicians — a shortage that exists at the same time that the Affordable Care Act moves into enactment — it is more important than ever that these nurse practitioners be allowed to fully use their skills and compassion to help serve the country’s increasing health care demands.
Nurse practitioners are registered nurses who have completed graduate-level education — either a master’s or doctoral degree — and who are able to deliver a wide range of primary, acute and specialty care services. This includes prescribing or renewing prescriptions for most drugs; ordering blood tests; performing routine medical examinations; monitoring chronic conditions; counseling patients about prevention; and treating colds, sore throats and the flu.
Outdated barriers in nearly two-thirds of our states prevent nurse practitioners from working with patients to the full extent of their skills. In a policy briefing addressing the scope of practice issues that was published this past October by the Robert Wood Johnson Foundation and Health Affairs, it was noted that currently only 18 states and the District of Columbia allow nurse practitioners to diagnose and treat patients and prescribe medications without a physician’s involvement. The remaining 32 states, California among them, require physician involvement to diagnose and treat or prescribe medications or both. For example, Montana allows nurse practitioners to work without any doctor supervision. By contrast, Texas requires a doctor’s direct, on-site supervision at least 20 percent of the time.
Nurse practitioners not only have advanced academic credentials but on average have already worked     10-plus years as registered nurses, so they have practical, bedside experience to complement what they’ve learned in the classroom. And studies have shown no difference in outcomes when patients are treated by a nurse practitioner or a physician.
I worked as a geriatric nurse practitioner in a long-term care Veterans Administration facility in Illinois for several years. During that time, I appreciated the autonomy and leadership that being a nurse practitioner provided and the respect that was given me by the patients, staff and physicians I worked with. I was able to deliver timely, appropriate care without a physician’s involvement — and this, in turn, served our patients very effectively.
The confidence that Americans have in nurse practitioner-delivered health care is evidenced by the more than 600 million visits made to nurse practitioners every year. Nurse practitioners work as partners with their patients, emphasizing the health and well-being of the whole person and helping them make educated health care decisions and healthy lifestyle choices.
The addition into the health care system of as many as 35 million newly insured individuals under full implementation of the Affordable Care Act will create enormous demands that the current system is simply not prepared to handle unless we look to nurse practitioners to fill the gaps in providing needed care.
The influx of newly insured patients will also have a profound effect on where people receive care. When appropriate, some patients may prefer to receive treatment for minor conditions in a more convenient setting than a doctor's office, such as a retail clinic with evening hours. And with a greater national focus on prevention rather than just treatment, I believe nurse practitioners offer the best cure for the physician shortage.
Removing outdated barriers and allowing nurse practitioners to practice to the full extent of their experience and education will serve the health care industry, the profession and, most importantly, the patient, in the best possible manner.
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