60 Minutes statements on NPs: 'explosive'
I hope the segment on nurse practitioners aired April 19 on 60 Minutes has provoked the deserved level of alertness in most practicing family physicians.
The Oxford Health Plan, defined by 60 Minutes' Morley Safer as one of the largest HMOs in the Northeast, is listing Edwidge Thomas, R.N.P., in its roster of participating physicians. For the first time, managed care companies are paying nurse practitioners the same fees as doctors.
The dean of the Columbia University nursing school, Dr. Mary Mundinger, is described as the force behind a pilot project, Columbia Advanced Practice Nurse Associates, which opened an ambulatory facility in Manhattan run solely by nurses. Mundinger raised money from various foundations to pay for a million-dollar ad campaign to get the word out. Here are some quotations from the interview:
Mundinger: "Nurses can pick up when something's going wrong very early because of their engagement with people. They really know the individual they're working with."
Safer: "The nurse is no longer the bedpan-fetching slave to the genius doctor. For primary care, the nurse is in, and the doctor may well be on his way out. ... Twenty-six states now allow nurses a full range of responsibilities. They receive Medicare and Medicaid payments. A congressional study concludes that they deliver primary care as effectively as doctors."
Thomas: "We can do anything a primary care physician can do."
Nancy Dirubbo, A.R.N.P., of Laconia, N.H.: "I think you will see more nurse practitioners doing preventive health care and perhaps having a stronger foothold in an outpatient setting. And maybe we're going to be seeing physicians' roles evolving to the point where they do more inpatient setting. ... You don't need an astronaut to fly an airplane."
Each one of the above statements is potentially explosive. We must be able to ask ourselves if there is a future for primary care physicians, we must be able not to feel uneasy when our medical students ask about the future and the promise of family practice. The resources of the AAFP should be mobilized for this battle for the preservation of present and future generations of family physicians.
ALESSANDRO BERTONI, M.D.
Naples, Fla.Editor's note: Academy leaders have objected to the negative publicity Columbia Advanced Practice Nurse Associates is generating about nurse practitioners' roles vs. physicians' roles. AAFP President Neil Brooks, M.D., wrote 60 Minutes April 23, saying, "Edwidge Thomas' statement that '(nurses) can do anything that a primary care physician can do' sounds as if the provision of primary care is no longer about medicine."
Brooks said a typical NP program requires a baccalaureate in nursing or the equivalent, plus two years of classroom and clinical course work. "This is appropriate, comprehensive training for a nurse practitioner," Brooks said. "It certainly is not acceptable on an application for a physician's license."
In addition, AAFP Director Bruce Bagley, M.D., of Albany, N.Y., was featured in an April 30 Physicians Financial News story on CAPNA. Bagley is part of a 10-physician practice employing two physician assistants and an NP.
"Our nurse practitioner does not work when there is not a physician available. It has nothing to do with trust. It's just that, much like my own training as a family physician is to know what my limits are, when to ask for help ... both NPs and PAs have that same bent. They will see things up to a level at which they feel uncomfortable, and there needs to be readily available consultation," Bagley explained.
FP Report is published by the AAFP News Department. Copyright © 1998 by American Academy of Family Physicians.