Common-sense solutions can resolve primary-care shortage 

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  • The Association of American Medical Colleges says there will be a shortage of 65,800 primary-care physicians by 2025.
Congress should reauthorize and fully fund nurse practitioner residencies in primary care clinics. Though relatively new, these programs can play a key role in addressing America’s burgeoning primary care crisis.

Here are five reasons why:

First, the country already lacks enough primary-care physicians to meet our health care needs. The problem is especially dire in underserved communities, both rural and urban, where federally qualified health centers and nurse-managed health clinics deliver a huge portion of primary care.

Second, the primary-care shortage is worsening due to the Affordable Care Act and the aging U.S. population. According to the Association of American Medical Colleges, by 2025, there will be a shortage of 65,800 primary-care physicians. Unless we make a full-bore effort to revitalize the provider pipeline — physicians, nurse practitioners and physician assistants — increasing numbers of needy Americans will be unable to receive the care they need, even if they are insured.

Third, a substantial body of research has shown that for the overwhelming majority of primary-care concerns, nurse practitioners, or NPs, perform as well as physicians on clinical outcomes and patient satisfaction. Moreover, NPs can be trained faster and less expensively than physicians and have demonstrated a willingness and ability to work in underserved areas. This does not negate the need for more physicians, but we desperately need all hands on deck.

Fourth, despite the research showing NPs’ excellent clinical results, newly graduated NPs are often discouraged from joining federally qualified health centers because of the intensity and demands of providing service in these complex clinical settings. In fact, the Institute of Medicine’s 2011 report, The Future of Nursing: Leading Change, Advancing Health, called for residency programs, partly in response to concerns that newly graduated NPs will not have had enough experience or training.

This leads to reason No. 5: Nurse practitioner residencies address these concerns. The residencies provide an extra year of hands-on training for newly graduated NPs, often including the opportunity to work in teams with physician colleagues, much as primary-care physicians work with specialty colleagues. While it is too soon to rigorously gauge the value of the first wave of NP residency programs, residency is a proven model for training physicians, and the anecdotal evidence about NP residencies — including from our own program in collaboration with Glide Health Services in San Francisco — is quite encouraging.

Inspired in part by Dr. Margaret Flinter, an advanced-practice nurse who is the country’s leading advocate for NP residencies, Congress originally authorized a three-year pilot program (2011-14) that established nurse practitioner residencies in federally qualified health centers and nurse-managed health clinics as part of the Affordable Care Act. Now U.S. Sen. Bernie Sanders, D-Vermont, has proposed that the NP residencies be reauthorized and funded at $75 million for the next five years.

On Wednesday, Flinter testified in front of the Senate Health, Education, Labor and Pension Committee in support of that proposal. Hers is a voice the entire country — not just politicians and health care professionals — needs to hear.

After all, in the short term, reauthorizing and funding another five years for NP residencies is an effective, economic way to extend the primary-care workforce in the clinics implementing these programs. Long-term, it gives researchers and policymakers an opportunity to rigorously gauge the value of the NP residency concept and establish best practices.

Given the urgent nature of the primary-care crisis, the history of NPs delivering exemplary primary care and the low-risk, high-reward nature of this proposal, how can we afford not to support its reauthorization and funding?

I urge both the health care community and members of the general public to ask their representatives in Congress to support this desperately needed program.

David Vlahov is dean and professor at the UC San Francisco School of Nursing.

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David Vlahov

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