Doctors to Lawmakers: Remember, People Like Us

Physicians look to leverage their popularity amid contentious debate over nurses.

Dr. Martha Perez examines Maria Lebron in a room at the Community Health of South Florida, Doris Ison Health Center on February 21, 2013 in Miami, Florida.
National Journal
Sam Baker
Dec. 18, 2013, 9:46 a.m.

Fam­ily phys­i­cians have a mes­sage as Con­gress and state le­gis­latures con­sider a range of policies that would squeeze doc­tors’ pay: People still want their doc­tor in charge.

There’s a short­age of primary-care doc­tors in the U.S., and de­mand is about to surge be­cause of the cov­er­age ex­pan­sion in the Af­ford­able Care Act. As a res­ult, many states are con­sid­er­ing meas­ures that would let nurses and nurse prac­ti­tion­ers take on more re­spons­ib­il­ity.

But the Amer­ic­an Academy of Fam­ily Phys­i­cians says that’s not the an­swer—and that pa­tients won’t like it, either. Ac­cord­ing to a new sur­vey that AAFP com­mis­sioned, 72 per­cent of Amer­ic­ans say they want to see a doc­tor for their med­ic­al care, com­pared with just 7 per­cent who say they want to see a nurse prac­ti­tion­er.

AAFP’s sur­vey says people rate nurse prac­ti­tion­ers highly on at­trib­utes like be­ing “com­fort­ing” and “a good listen­er,” but rate doc­tors high­er on “who I want to see when I am sick.”

AAFP Pres­id­ent Re­id Black­weld­er said it’s “very en­cour­aging to have af­firm­a­tion” of what primary-care doc­tors already be­lieved—that they’re the ones people turn to and want to con­tin­ue to turn to.

Nurse prac­ti­tion­ers re­leased their own com­pet­ing poll last month, in which 62 per­cent of re­spond­ents said nurse prac­ti­tion­ers should be able to provide cer­tain ser­vices—such as writ­ing pre­scrip­tions and or­der­ing dia­gnost­ic tests—without su­per­vi­sion from a phys­i­cian.

The battle between nurse prac­ti­tion­ers and phys­i­cians is play­ing out ahead of a surge in de­mand for health care, with as many as 30 mil­lion people ex­pec­ted to come in­to the sys­tem through Obama­care. Primary care isn’t an es­pe­cially luc­rat­ive spe­cialty in the first place, and Black­weld­er said res­id­ency op­por­tun­it­ies for primary care will be in short sup­ply in just a few years.

“The work­force is­sue is huge,” he said.

In­stead of boost­ing nurse prac­ti­tion­ers’ role, AAFP wants law­makers to ad­dress the doc­tor short­age by fund­ing more res­id­ency pro­grams in primary care and in­creas­ing doc­tors’ pay­ments un­der Medi­care and Medi­caid.

But those pri­or­it­ies are all wait­ing in line be­hind a per­man­ent “doc fix,” Black­weld­er said. He said Medi­care’s pay­ment for­mula for phys­i­cians is the single biggest threat to primary-care doc­tors. AAFP sup­por­ted this year’s bi­par­tis­an, bicam­er­al push to per­man­ently re­place the for­mula, which calls for pay­ment cuts that Con­gress routinely delays. That ef­fort didn’t make it across the fin­ish line this year be­cause law­makers couldn’t agree on a way to pay for a per­man­ent fix.

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