nurse practitioners


When It’s OK To See A Nurse Practitioner, Physician Assistant — And When It’s Not

(Alex E. Proimos/Flickr)

(Alex E. Proimos/Flickr)

By Dr. David Scales

Let’s say you hurt your knee doing your best Tom Brady impression playing flag football.

It hurts like the dickens and you’re not sure if you tore something or just have a really bad case of tendonitis. You go to your local urgent care clinic, or doctor’s office, and you’re seen by a physician assistant  (PA), who examines you, says everything is structurally intact, and you should use ice, elevate your leg and take some ibuprofen for the pain.

What the PA said makes sense, but shouldn’t you see — you know — the doctor?

Well, maybe not. While it seems to make sense to always ask for an expert, there can be some downsides. It can take months to get an appointment with a doctor, or cost more to see them versus a PA or nurse practitioner (NP). Also, with the holidays approaching, it’s prime season for senior physicians to be away, with the rest of the health care team pitching in. So when is it fine to see someone besides the doctor for your medical care? And when should you avoid it?

Well, who else might you see at a medical clinic? In addition to a doctor, you could see a PA or NP. If you haven’t seen one yet, you will. Medicine is increasingly becoming a team sport, requiring well-synchronized “pit crews rather than isolated physicians. In Massachusetts, for instance, there are already close to 8,000 NPs and over 2,000 PAs and those numbers are rising to fill a growing shortage in primary care. A 2013 study estimates that Massachusetts will need 725 more primary care providers by 2030.

I asked a few NPs and PAs — each with at least five years of clinical experience, and some with more than 30 — what they think patients should know about all this. They agreed that it’s best to focus on experience rather than the degree behind the name. An NP with three decades of experience may be more knowledgeable than an MD who just finished their residency — and I say that as someone who is just about to finish residency.

One of those NPs with over 30 years experience is Lynne Crawford, a primary care NP at Cambridge Health Alliance. She phrased it this way: “If you see someone and you’re uncomfortable with the encounter, it might be your rapport with them rather than the degree behind their name.” Continue reading

Unanimous Committee Thumbs Up For Primary Care Bill

Rep. Jeffrey Sanchez

This just in from the office of Rep. Jeffrey Sanchez, co-chair of the committee:

BOSTON—The Joint Committee on Public Health voted unanimously in favor of “An act supporting the practice of primary care in the commonwealth.” Sponsored by Representative Jeffrey Sánchez, co-chair of the Committee, the bill eases statutory burdens to maximize the role of physician assistants and nurse practitioners in order to improve access to care for patients and free up physicians’ time for complicated cases requiring their expertise.

“While Massachusetts’ 2006 health reform made incredible gains in coverage, further work is required to transform the health care workforce into a more team-based approach to primary care,” Sánchez said. “As the Commonwealth moves forward in payment reform, it is crucial that we have a strong primary care workforce that can ensure all our residents are healthy and have access to quality care.”

In the context of payment reform, the Rand Report to the Special Commission on the Health Care Payment System projected savings up to $8.4 billion over 10 years if we enhanced patient care through increased utilization of nurse practitioners and physician assistants.

Increasing the number of primary care practitioners requires a multi-faceted approach. The bill reported out of Committee was amended to include a special commission on family physicians and other primary care physicians in community care settings.

As Rachel wrote here in April, the Massachusetts Medical Society opposed several bills this session that sought to enhance the status of non-physician providers, from nurse midwives to physicians assistants, arguing that they could endanger patients. (Jeff Sanchez’s response to their opposition is here.)

On other bills, from the public health committee:

The Committee also favorably reported bills relating to the scope of practice of optometrists and podiatrists, allowing for these providers to treat more conditions within the scope of their education and training, increasing access to these services.
Other bills reported favorably include An Act to eliminate racial and ethnic health disparities in the Commonwealth, An Act to establish community based grant programs to eliminate racial and ethnic health disparities in the Commonwealth and An Act to increase routine screening for HIV.