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Meeting the Challenge of Extending Care

Meeting the Challenge of Extending Care

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.