Nurse practitioners fill critical health care gaps

Last week, I wrote about physician assistants (PAs), most of whom practice in collaboration with a physician and are an increasing presence in primary care. As a nurse myself, I wanted to make sure to discuss another medical professional who’s helping to fill the gaps in primary care: the nurse practitioner (NP).

NPs are not doctors, obviously, though some hold DNP — doctor of nursing practice — degrees. They are a subset of Advanced Practice Registered Nurses (APRNs), whose numbers also include nurse midwives, nurse anesthetists and clinical nurse specialists.

There are about 385,000 NPs in the U.S., a number that has about doubled in the last 10 years, according to the American Association of Nurse Practitioners. I was surprised to learn that NPs make up about 40% of primary care providers in the U.S.

As I noted last week, the Association of American Medical Colleges projects we will be short as many as 48,000 primary care doctors by 2034, so — like physician assistants — nurse practitioners are playing an important and growing role in providing health care.

How do the educations of MDs and NPs compare?

Post-undergraduate education for doctors includes at least four years in medical school and a minimum of three years completing their residency, in addition to specialty education and fellowships.

Nurse practitioners first complete registered nurse (RN) requirements before advancing to NP. This includes, like MDs, four years of undergraduate education in biology, physiology, anatomy and genetics. They also complete clinicals as an RN student and have to pass the rigorous licensing exam, the NCLEX-RN.

Most RNs practice for two to three years before completing a two- or three-year MSN (master of science in nursing) program or earning a DNP to become an NP.

How are RN and NP jobs different?

Although both registered nurses and nurse practitioners focus on patient observation and care, the largest difference between the two is that NPs are permitted to order tests, perform diagnoses and prescribe treatments — duties normally performed by physicians — whereas RNs are charged with carrying out a treatment plan.

The other major difference is that, in 27 states and the District of Columbia, NPs are allowed to establish independent practices, but only after hundreds of hours of clinical experience and mentorship under the supervision of a physician. In Illinois, NPs cannot practice independently; instead, they must establish a collaborative practice with a physician.

This ability to practice independently allows NPs to set up shop in underserved areas and care for rural, nonwhite and low-income patients. A 2022 report said that, while the number of doctors has decreased in rural and low-income areas, the supply of actively practicing NPs has actually increased.

How do MDs feel about NPs?

The American Medical Association is against what it calls “scope creep” in NP practices. While it acknowledges the importance and contributions of nurse practitioners, it says, “Patients deserve care led by physicians — the most highly educated, trained and skilled health professionals.”

And yet.

With their focus on preventing disease, studies have found that nurse practitioners help patients minimize their medical costs by reducing emergency room visits and using preventive treatment. A study of veterans assigned to NPs at Veterans Affairs health facilities found that NPs provided similar quality of care for those with chronic disease and that there was little difference in patient outcomes compared to MDs.

The bottom line

As you may have found, it might take days or weeks for you to get in to see a physician. Nurse practitioners are helping physicians care for more people more quickly, and they have increasingly become the backbone of the health care system.

So if you encounter a NP at your doctor’s office, you might discover that they take more time with you, give you more information and maybe even remember your name. The quality of care you receive depends, not on whether the provider is an MD or an NP, but on the quality of your relationship. A good relationship and good communication will help you better take charge of your health.

There’s no question that MDs have more specialized skills, knowledge and experience. As with physician assistants, if you’re dealing with a rare health condition or one that may require surgery, you will be under the care of an MD. That’s as it should be.

But as the number of primary care doctors dwindles, we have to broaden our definition of “health care provider” to include both nurse practitioners and physician assistants.

• Teri (Dreher) Frykenberg is a board-certified patient advocate. A critical care registered nurse for 30+ years, she is founder of NShore Patient Advocates (www.NorthShoreRN.com). Her book, “How to Be a Healthcare Advocate for Yourself & Your Loved Ones,” is available on Amazon. She is offering a free phone consultation to Daily Herald readers; email her at teri@northshorern.com.