The Primary Care Physician Shortage [Part II]: Is The Answer Giving Nurses And Pharmacists License To Do More?

April 15, 2014

If the ACA is successful, eventually we’ll have as many as 30 million more people who will be insured. As it stands, we don’t have enough primary care physicians to meet this new demand. There are many possible solutions. We’re exploring 3 of them in a series of posts:

1. Shortening the amount of time it takes to get a medical degree and expanding residency programs to get more doctors into the workforce more quickly.

2. Empowering medical professionals to take on more of the responsibilities of primary care physicians, working under their supervision. These professionals include physicians’ assistants, nurse practitioners, pharmacists, nurses and others.

3. Using technology – telephones, email and telemedicine — even remote monitoring — to extend the reach of physicians — especially for people in remote and rural areas.

This is Part II of a 3-Part Series. Click here for Part I in the series and come back to the blog for Part III in coming weeks.

First, some startling statistics.

Doctors spend an average of just 12% of their day with patients. According to another study, new doctors spend just 8 minutes with patients during an appointment providing “direct care.” The rest of their time is spent filling out forms or reading charts, also known as “indirect care.”

Doctor time is at a premium as it is — split between roles as form filler, prescription writer and primary care giver — and their time is about to stretched even thinner. As people newly insured under the Affordable Care Act go to primary care physicians (PCPs) for the first time, doctors will be hard-pressed to keep up.

This is where nurses and pharmacists come in.

Many health care experts have suggested that transferring some of the responsibilities of PCPs to local pharmacists and nurse practitioners will free up physicians and result in better care for patients.

The Doctor Pharmacist Is In

“[Pharmacists] are the most overeducated and underutilized healthcare professionals in the U.S.,” said R. Pete Vanderveen, dean of the USC School of Pharmacy. “It doesn’t take eight years of education and a professional doctorate to fill a bottle with pills.”

Pharmacists can already give immunizations and provide some in-person consultations. Some legislation is already on the books, in places like California, that goes further — enshrining in law an expanded role for pharmacists.

California, New Mexico and North Carolina already have laws expanding pharmacists’ roles. For example, California’s pharmacy practice bill, SB 493, allows advanced pharmacists to perform the following activities:

  • Perform patient assessments
  • Order and interpret drug therapy-related laboratory tests
  • Refer patients to other providers
  • Initiate, adjust, and discontinue medications under physician protocol
  • Work with other health care providers to evaluate and manage a patient’s health issues

This bill provided the dual benefit of reducing the workload of doctors and the incidence of avoidable (and costly) hospital admissions. It also better used the skill set of pharmacists with advanced degrees.

APRNs, Not MDs

Florida bill would similarly expand the role of non-MDs in providing care, authorizing advance practice registered nurses (APRNs) to act independently of physicians in select circumstances. The primary reason for doing this would be to provide access to remote communities that may not live near a primary care physician.

Nurses with this authorization could sign documents that currently require a physician’s signature and have the opportunity to be designated “Independent Advance Practice Registered Nurses” after a certain amount of training and experience. They would still need supervision for certain procedures.

Lawmakers who voted for the bill insist that none of the expanded roles given to these APRNs would go beyond the scope of their training, so patient safety should not be an issue.

This concession speaks to a recurring concern around expanding the role of both pharmacists and nurse practitioners. Namely, that it could be a dangerous shortcut that exposes patients to unlicensed care.

However, as long as the expanded roles of both care providers remains within the scope of their respective trainings and maintains some degree of physician supervision, it has the potential to provide relief to overworked PCPs and improved care to people in underserved areas.

3 Responses to “The Primary Care Physician Shortage [Part II]: Is The Answer Giving Nurses And Pharmacists License To Do More?”

  1. Anne said

    These initiatives should be carefully monitored as those “extenders” don’t always know what they don’t know.” Furthermore, if you are going to increase nurses, pharmacists, etc duties, then their compensation should be looked at……shifting some of the revenue from the MDs to these folks is a start to incentivize these folks. Overall, quite frankly, I believe the care would improve with nurse an pharmacists as they have a scope of practice that is underutilized.


  2. […] is Part III of a 3-Part Series. Click here for Part I and here for Part II in the […]

  3. […] is Part III of a 3-Part Series. Click here for Part I and here for Part II in the […]

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