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Nurse Practitioners, Physician Assistants Fill Void

Although the length of training and regulations vary among the states, PAs are usually registered to practice after three to four years of training; advanced nurse practitioners go through at least four years of training but usually six or more years. While physician assistants may work independently in some settings, they’re always under a doctor’s supervision. NPs are generally granted more independence to diagnose and treat patients under state rules, although a majority of states still require some collaboration with a supervising doctor.

Some surveys already show that more primary care patients are seen by a nurse or physician’s assistant than by a doctor.

Not all doctors are happy about the trend.

“The nurse practitioner replacing the family doctor is not good for America,” said Dr. Ted Epperly, president of the American Academy of Family Physicians who runs a multiclinic general practice in Boise, Idaho. “To say a nurse practitioner can fill the shoes of a family physician, in terms of total comprehensiveness, is just not true.”

Across the Potomac River, a recent Monday brought many patients in to see nurse practitioners at the

MinuteClinic in a CVS Pharmacy in Dale City.

“I think a lot of them came in because their regular primary care offices weren’t open or had staff missing,” said Anne Pohnert, a nurse practitioner who directs 13 clinics across Northern Virginia staffed by nurse practitioners and physician assistants.

With some 500 clinics nationwide, MinuteClinic is the biggest of several medical providers that have set up shop in nearly 1,100 retail stores around the country.

Surveys have found that up to 60 percent of the retail clinic patients don’t have a primary care physician, although most have insurance.

Key to the success of the retail clinics is the limited menu of services. If patients have more serious problems, they are sent elsewhere.

“We’re here for the busy professional commuting to work or the busy mom with a million places to go. We do a lot of pink eye and strep and ear aches,” Pohnert said. “We take a lot of patients away from ERs who should not be in the ER.”

In Minnesota, Blue Cross/Blue Shield members pay no co-pay, nothing out of pocket, to visit a retail clinic. In Ohio, the Cleveland Clinic is setting up a system to connect electronic medical records between the health system and MinuteClinic sites in the region.

“These sorts of collaborations assure that people have better access to quality primary care out in the community,” said Hansen- Turton. “It gets them out of crowded waiting rooms.”

States that allow nurse practitioners full authority to diagnose, treat and prescribe drugs are Alaska, Arizona, District of Columbia, Idaho, Iowa, Maine, Montana, New Hampshire, New Mexico, Oregon, Rhode Island, Washington, Wyoming.

© YellowBrix 2009

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