Ever had trouble getting an appointment to see your primary care physician? It’s frustrating – especially if the only alternative you have is to go to urgent care and see a doctor you’ve never met and then shell out the higher co-pay.
Accessing care may get harder as hundreds of thousands of people in North Carolina get health insurance under federal health care reform. North Carolina already has a shortage of primary-care physicians – 91 of the state’s 100 counties are designated as medically under-served. The new influx of patients will further strain the system.
Enter nurse practitioners. North Carolina has nearly 4,500 nurse practitioners, and they are increasingly in charge of primary care for people throughout the state. Nurse practitioners are nurses with advanced degrees (usually master’s degrees) and state certification. They can write prescriptions and provide patient care, but currently state law requires that they do so under a doctor’s supervision. The American Academy of Nurse Practitioners says 96% of the profession is women.
This change has been underway for the past two decades. The NC Institute of Medicine reports that “while the number of primary care physicians grew 36% from 1996 to 2005, the number of primary care physician assistants doubled and primary care nurse practitioners grew 220%.”
The UNC system recently approved a Doctor of Nursing Practice (DNP) degree, with the intention that it will eventually replace the current two-year Master of Science in nursing. So the next generation of nurse practitioners will be doctors, but not MDs.
Both in North Carolina and nationally, the increased need for primary care providers is sparking a turf war between nurse practitioners and doctors. The NC Medical Society, for example, is pushing to make sure current restrictions on how nurse practitioners treat patients and what procedures they can perform stay in place. They’re also pushing hard for a bill that would put additional restrictions on nurse anesthetists.
The desire for quick and easy-to-access health care for minor problems is already evident. Take for example the new clinics in Target stores – staffed by nurse practitioners. Many people just don’t want to go through the trouble of making a doctor’s appointment for a flu shot or get treatment for a sinus infection or some other common ailment.
Whether our current legislature decides to increase regulations on nurse practitioners will impact your access to health care. Depending on what they decide, you may soon find that when you actually need a doctor, you can’t get an appointment.