A very long time ago, my first job out of graduate school was with the
University of Mississippi Medical School in a program to train registered
nurses to become Certified Nurse Midwives (CNM). The nurses committed
to work a minimum of two years after receiving their Master Degree and
their Certification in a ‘prepared site’ somewhere in the
six southeastern states.
Why was there such a program? There was a dearth of practitioners available
in many towns and cities in this region to care for the extensive maternal
and child needs of much of the population. In specific locales in this
region the statistics for maternal and infant mortality rivaled that of
third world countries. There was, in short, a crying need to improve health
in a chronically underserved area of the country. In the six states of
the Gulf Coast region, the newly minted CNMs, began caring for women,
addressing nutrition, blood pressure, weight, and the many issues related
to premature birth, miscarriage and poor neonatal outcomes. They delivered
babies in hospitals, birthing centers and yes, at home. They delivered
the kind of care that all mothers-to-be deserve and need to have. And
the poor statistics began to improve. Every year they improved.
Why share this story? The nurse midwives in this story are professional
nurse practitioners concentrating in obstetrics and neonatal care. They
made a difference and they still are; as are nurse practitioners of every
specialty. These professionals, now broadly referred to as physician-
extenders, cover a broad spectrum of service for all of us. And we should
also add physicians assistants to this discussion.
Today, with the Accountable Care Act promising increased access to care
for millions more people, there is a small problem. The availability of
primary care practitioners in this country is insufficient, and some would
say bordering on crisis proportions, to meet the needs and demands of
the newly covered or insured.
Sadly, for the first time since the Great Depression the ratio of physicians
to population is about to decline and there is projected to be a shortage
of well over 100,000 physicians in the next ten years. There are many
reasons for this, and the issue is real. These issues must be addressed.
Nurse practitioners and physicians assistants can be part of the solution
to improve quality, patient satisfaction, access to care and all at lower cost.
What is the delay in extending these very capable practitioners to serve
more people? In my past experience, there was resistance from those in
medical practice who saw these talented and well-educated CNMs as an economic
threat to their livelihood and/or who, incorrectly, questioned their competence
and professional skill. Today resistance extends to all specialties of
nurse practitioners and physician assistants, and most often for the very
same reasons as from decades before.This resistance-though less now than
in the past-is a major part of the problem.
Within their approved scope of practice, nurse practitioners and physician
assistants are outstanding, proven providers of needed services. Both
nurse practitioners and physician assistants are an integral part of coordinating,
delivering and improving health care for many. If this country is to meet
the aim of improving access to care, at a higher level of quality and
for a lower overall cost, nurse practitioners and physician assistants
must be a part of the new health care story.