Opposition to Nurse Practitioners? Let's pick our battles carefully

I visited with Senator Jeff Bingaman’s health staff this week.  (I am a voter in New Mexico, where we have a growing coalition of primary care advocates.)

They told me, and it has been confirmed by others, that the ACOP is organizing an opposition among the primary care groups to bills that allow non-physicians to be primary care providers. In a state like New Mexico, where there is a dire shortage of primary care providers, any primary care reform has to involve nurse practitioners, which makes this opposition so disappointing to Senator Bingaman, who is poised to become the leading figure in the Senate Health Committee. If we want a medical home bill, we must be prepared to advocate strongly for it. Otherwise, it will lose.

It would be indeed unfortunate if the medical home coalition, building so successfully over the past couple of years, died on the vine because of opposition to non-physician providers.

As long as we think clearly about what the medical home is geared to (first contact, person focused care over time, comprehensive, and coordinated), and gear our qualifications as medical home provider to achievement of these goals, we have nothing to fear from non-MD primary care providers.

The point is to keep our eye on what it is we want to achieve, and not get distracted by secondary considerations which, in the end, we can manage by being firm about what primary care really is.

I hope that the American College of Physicians  actions will not do anything to jeopardize the medical home movement.  If we are supportive of Congressional bills that are aimed at building primary care in the US, I think something very important will come out of Congress this year.

Barbara Starfield MD MPH (shared with her permission)

Comments

[Jean Antonucci]

This is a vital and crucial point and makes me very fearful. I have long been watching physicians oppose lots of professionals who could help us take care of patients. Makes me embarrassed.
Pharmacists are never, for instance allowed to be as integral a part of the team as they could be Psychologists, midwives, midlevels, you name it .This frightens me no end. Starfield has it right ,but this is one more very steep hill to climb to change healthcare .
When I have participated in local conversations about this, FPs are the ones who get this Specialist seem far more involved in turf battles--why?-- and I fear greatly this factionalism will work against true health care reform.

I guess I think that if this administration in Washington does not accomplish things, does not turn this big heavy ship in the right direction then the USA this modern roman empire, has come to a corrupt hopeless end.

[L Gordon Moore]

Dr. Starfield makes a very important point. The New York Times today is reporting that the insurance industry and others are setting aside tens of millions of dollars to fight against health care reform, just like they did 15 years ago.
Real reform is our objective, this is not the time to divide our strength and divert our attention by attacking our colleagues.