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Nurse Educators and Family Physicians Advocate Better Cooperation Between the Professions

More Needs to Be Learned About Role of Nurse Practitioners

FOR IMMEDIATE RELEASE
Thursday, September 05, 2002

Contact:
Leslie Champlin
American Academy of Family Physicians
(800) 274-2237, Ext. 5224
lchampli@aafp.org

WASHINGTON  In a unique collaboration, a team of family physicians and nurse educators examined the working relationship of the two professions and developed recommendations for joint advocacy, study and work. “Can Nurse Practitioners and Physicians Beat Parochialism Into Plowshares?” in this month’s Health Affairs calls for a combined, consistent effort in place of turf battles to achieve the best results for patients.

“There are over 100,000 nurse practitioners and yet we know so little about what they do, where they are and how to fully make the most of their contributions to patient-centered care,” stated Robert Phillips Jr., M.D., lead author and assistant director of the Robert Graham Center: Policy Studies in Family Practice and Primary Care, Washington, D.C. “They are a much needed part of the health care workforce.”

“The country can ill afford doctors and nurses who ignore one another’s capabilities and fail to maximize each other’s contributions cost-effectively,” said Mary Wakefield, a nurse who co-authored the article and director of the Center for Rural Health at the University of North Dakota, Grand Forks.

The nurse practitioner role has evolved since its creation in 1965 and has faced both internal and external differences of opinion about the NP’s role and responsibilities. Tensions rose as NPs sought expansion of practice autonomy and independent reimbursement. Physician organizations responded by seeking control of NP practice through mandating supervisory relationships, keeping responsibility for patients, and limiting direct reimbursement to NPs. However, some collaboration takes place in the public policy arena, and effective practice models of physician-NP collaboration are common.

The authors cited Donald Berwick, M.D., a leader in health care quality and patient safety, who noted, “Achieving the highest-quality health care system will require shedding of the old model in which professional roles trump teamwork.” The authors hope that “prestige, position, and payment yield to patients, populations, and performance.”

In order for effective collaboration to happen, the authors list systemic changes that will need to be made:

Revision of payment systems: Echoing recommendations in the Institute of Medicine’s Crossing the Quality Chasm, the authors support changes to payments methods that encompass the scope of practices received. They argue that current payment methods don’t encourage a multidisciplinary team approach.
Definition of shared authority and accountability: No health care profession practices independently anymore, so statutory language, professional organization policies and separate ethical principles may be outdated for both nurse practitioners and physicians.
Stipulation of integrated education and certification requirements: Educating new generations of physicians and NPs for collaborative, patient-centered care is important.
Funding of health services research focused on integrated care models: While some general research has been conducted on the characteristics of effective teams and team interactions, assessments of specific characteristics of integrated care models and related patient outcomes are still limited.
Assessment and planning the workforce jointly: When nursing and medicine separately consider supply within their own disciplines, they tend to underestimate the combined effects on needs and resources – multidisciplinary workforce efforts might improve results.

“While there is evidence that integrated NP-physician practice enhances care, more research is needed to develop an evidence base to optimize delivery models. Furthermore, education, regulation, and payment policies that support evidence-based NP-physician approaches to care delivery should be encouraged,” conclude the authors. “Will physicians and NPs set parochialism aside and embrace improved patient care as a shared priority? The American public deserves no less.”

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The Robert Graham Center conducts research and analysis that brings a family practice perspective to health policy deliberations in Washington. Founded in July 1999, the center is an independent research unit working under the personnel and financial policies of the American Academy of Family Physicians.

Founded in 1947, the American Academy of Family Physicians represents more than 93,500 physicians and medical students nationwide. It is the only medical specialty society devoted solely to primary care. Please visit www.aafp.org for more information about AAFP.

Founded in 1947, the AAFP represents more than 93,000 physicians and medical students nationwide. It is the only medical society devoted solely to primary care.

Nearly one in four of all office visits are made to family physicians. That is 215 million office visits each year – nearly 48 million more than the next medical specialty. Today, family physicians provide the majority of care for America’s underserved and rural populations.

In the increasingly fragmented world of health care where many medical specialties limit their practice to a particular organ, disease, age or sex, family physicians are dedicated to treating the whole person across the full spectrum of ages. Family medicine’s cornerstone is an ongoing, personal patient-physician relationship focused on integrated care.

To learn more about the American Academy of Family Physicians and about the specialty of family medicine, please visit www.aafp.org.

For more information about the AAFP's positions on issues and clinical care and downloadable multi-media on family medicine and health care, visit the AAFP Media Center.

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