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Nurse Practitioners Are Team Members, Not Leaders, in the PCMH
Everyone involved with health care -- from health care workers to policymakers to physicians -- needs to recommit to increasing quality and lowering costs. That is a commitment that the AAFP both embraces and applauds, which is why the Academy has worked so hard to advance the patient-centered medical home, or PCMH, model of care. We believe it has the potential to both increase quality and lower costs.
Notably, health care provided by a team of health care professionals and other providers -- a team that includes physicians, nurses, nurse practitioners, physician assistants, and, as necessary, therapists, subspecialists, and hospitals and other facilities -- is at the heart of the PCMH. This team-based approach will lead to the most comprehensive, patient-centered care for patients. But the Academy also believes strongly that medical homes need to be physician-led and that primary care should be at the base of the health care pyramid.
AAFP Provides Resources on Nurse Practitioners
An NP's training, education and clinical expertise cannot replace that of a primary care physician. Both professions have plenty of demand for their skills. And when they join together to provide care for patients in a team setting, those skills are put to the best use. The team approach gives the patient access to the full range of health care services without sacrificing the medical expertise that ensures the most accurate diagnoses and the most appropriate treatments in the most timely manner.
Although some organizations argue that it is easier and faster to train nurses than it is to train physicians, the shortage of nurses extends to a shortage of nursing educators. According to the AACN, "U.S. nursing schools turned away 54,991 qualified applicants from baccalaureate and graduate nursing programs in 2009 due to insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints." In addition, almost two-thirds of nursing schools say faculty shortages are the reason they cannot accept more entrants into their programs.
Jumping on the Bandwagon
In short, there are a lot of health care providers jumping on the PCMH bandwagon as it becomes an increasing viable model for national health care going forward. We've heard claims from everyone from pharmacists to ophthalmologists that they can provide a medical home. Obviously, they are an important part of the medical home team, but their practices are not true medical homes. Likewise, NPs have a place on the team, but that team needs to be led by a physician to ensure patients are receiving the care to which they are entitled and which our health care system has promised them.
In the end, it really should be all about the patient, but among all the rhetoric about who or whose practice is or isn't a medical home, it is the patients who are … or seem to be … getting lost. Patients are the key focus of the medical home team, and every medical professional needs to remember that. Our patients deserve the best care possible. We must make sure our health care system remains grounded in the patient's interests. And those interests are best served by a physician-led team of health care professionals all doing what they have been educated and trained to do best.
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More From AAFP
The AAFP on the Role of Nurse Practitioners in the U.S. Health Care System
Primary Health Care Professionals: A Comparison