I am a huge fan of anything that boosts patients’ access to care. Medical doctors, doctors of osteopathy, nurse practitioners, physicians’ assistants, Minute Clinics, Urgent Care clinics, telemedicine, AI med chatbots, Dr. Google, etc. I’ve advocated for more over-the-counter drugs that patients can use to treat themselves. I’ve written about creating a third class of drugs that pharmacists could dispense without a doctor’s prescription. I’ve proposed delegating more authority to pharmacists by giving them a list of drugs they can legally dispense without FDA regulatory changes. I’ve also complained about the thousands of medical school graduates who don’t match to a residency every year, many of which will never match and never be allowed to treat patients. It’s a huge waste of talent.
While in graduate school, I took numerous classes on research methods and research design. In one class we had to design a survey instrument and recruit people to take the survey. Those surveyed were mostly fellow students but that was fine. My project (circa 1992) was whether my fellow students, who were mostly adults getting an MBA, were willing to be treated by someone with less training than a doctor. At that time there were only around 30,000 to perhaps 35,000 nurse practitioners across the country. They had no practice autonomy and were only granted limited reimbursement for federal programs in 1989. For my research project I chose to avoid the (loaded) term “nurse” and instead I called my hypothetical practitioner a Master of Medicine.
I forget the exact percentages but more than 75% of those completing my survey said they were willing to see a masters level practitioner. The proportions varied depending on whether it was for a cold, a chronic disease or diagnostic care. My professor (a PhD) scoffed – literally laughed – at what an absurd idea it was to be treated by someone with less training than a physician. As I recall she gave me a B on the project, mostly because she thought it was stupid even though the project was about designing a survey Instrument.
Over the years various surveys have found that patients tend to like their NPs. Indeed, the satisfaction rates are often higher than for their doctors, often saying they felt less rushed than when seen by a physician and the NP listened to them more. The American Medical Association even grudgingly admits that NPs are “essential and valuable members of physician-led healthcare teams” but opposes expanding scope of practice on turf grounds. It’s easy to forget that seeing an NP was not common until the past 20 years or so. The first NP students enrolled in 1965. It took between 30 to 40 years before NPs gained the authority to do more than work as glorified nurses.
The Wall Street Journal reported on the recent death of the founder of the program for nurse practitioners, saying:
She was convinced that nurses could go well beyond their traditional role. Many doctors disagreed.
The problem was that physicians regarded themselves as the “lords of health,” as she put it. They were, and remain, determined to defend their turf.
She believed nurses could go far beyond hand-holding, wound-wrapping and temperature-taking. Nurses weren’t pretending to be physicians, she said in a 2016 speech, but wanted “to get away from being a handmaiden” to them.
When there is no doctor around, a nurse should be able to step in, prescribing medicine for a sore throat or advising a terrified parent at 3 a.m. Such was the conviction of Loretta Ford as a young nurse in rural Colorado in the 1950s.
Nurse practitioners have grown in numbers and practice authority since their inception. The boldness of NPs lobbying for more authority likely convinced physicians’ assistants to demand more as well. Only a few years ago the professional association for PAs announced they were happy with their role but have since demanded much of the same practice authority as NPs. More from WSJ:
Today, nurse-practitioner services are available across the country and overseas. About 385,000 nurse practitioners are working in the U.S., more than triple the total two decades ago. The aging of baby boomers is likely to create more demand for their services. (Physician assistants are a separate professional category, with different training, but perform many of the same functions.)
Loretta Ford went about creating the role of nurse practitioner in the 1960s, without asking permission of the medical establishment. She went on to earn a doctorate, became a professor of nursing at the University of Denver before accepting the position of dean of the nursing school at the University of Rochester in 1972. She died last month at 104.
Read more at WSJ: Loretta Ford, Who Helped Create the Role of Nurse Practitioner, Dies at 104