Delegates Call for Study of Nurse Practitioners

The Congress of Delegates has requested that the AAFP fund a study comparing the practices of primary care physicians and nurse practitioners. Specifically, delegates adopted a resolution Sept. 28 calling on the Academy to fund a Robert Graham Center study to evaluate the quality of existing studies that compare the two groups of health care professionals, including in terms of health care outcomes and cost effectiveness.

Delegate Nancy Swikert, M.D., of Florence, Ky., testified in the Reference Committee on Education that several studies have compared cost effectiveness of nurse practitioners and primary care physicians. However, many of the previous studies have focused on differences in pay between the two types of professionals and have ignored other factors, such as ancillary services, referrals and total expenditures.

Delegate Jack Chou, M.D., president of the California AFP, cautioned that such a study could produce results that members might not like, but alternate delegate William Thrift, M.D., of Prescott Ariz., said such research was necessary.

"No matter what we find out, we need to know," he said. "We need to have our own data."

Thrift said nurse practitioners need only 600 hours of clinical practice to practice independently in his state, compared to 12,000 hours for primary care physicians.

"Yet in Arizona," he said, "they can do the same work."

Delegate Barry Bennett, M.D., of Idaho Falls, Idaho, stressed that the study should focus on independent nurse practitioners, but he agreed that a study is needed.

"We need to have our own data because I can assure you the nurse practitioners are going to have their own," he said.

Student delegate Kevin Bernstein, of Quakertown, Pa., said such a study could help recruiting for the specialty.

"We need data really badly," he said. "It's hard to speak with our fellow medical students about family medicine. Their response is, 'Why am I going to go in to family medicine to do the same thing nurse practitioners do?'"

"We're in competition nose-to-nose with independent nurse practitioners," said delegate John Cullen, M.D., of Valdez, Alaska. "In states like mine, nurse practitioners can hang their own shingles with very little clinical experience, and the public doesn't understand that."

Delegates also reaffirmed two other resolutions related to nurse practitioners that reflect the AAFP's ongoing public relations efforts to educate the public on the differences in training requirements between physicians and nurse practitioners.

In other actions, the COD adopted an amended resolution that calls on the AAFP to evaluate and report on activities being taken to address the inadequate supply of family medicine preceptors nationally. In addition, the resolution calls on the AAFP to develop a partnership with the American Board of Family Medicine to explore incentives for precepting activities.

Delegates referred a resolution from the Reference Committee on Health of the Public and Science to the Board. The resolution calls on the Academy to develop a policy statement in support of the legalization of expedited partner therapy for gonorrhea and Chlamydia based on recommendations from the CDC.

Delegates from a handful of states -- including Illinois, Massachusetts, New York and Rhode Island -- where such treatment is legal testified in support of implementing a policy.

William Phillips, M.D., M.P.H., of Seattle, said expedited partner therapy has been tested in Seattle and Tacoma.

"It works," he said. "This will help patients and communities be healthier. It's a big problem, and this is part of the solution."