As Health Care Demands Grow, So Does Need For Nurse Practitioners

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A growing shortage of physicians means that more and more patients are seen by nurse practitioners. Because they are in demand, the nurses are looking at ways to gain more independence from doctors. Host Michel Martin speaks about this conflict with Kenneth Miller, director of the School of Nursing for the University of Delaware, and former independent nurse practitioner in New Mexico. He is also past president of the American College of Nurse Practitioners.


I'm Michel Martin, and this is TELL ME MORE from NPR News.

Just ahead, World Cup starts in about six weeks. We'll hear about how the competition is shaping up, as well as some of the off-field controversies that are making headlines. That's in just a few minutes.

But first, we want to talk about a looming issue in health care. Chances are when you go to the doctor, it's not the doctor taking your health history or giving you a physical exam and maybe not even prescribing your medication. It might be a nurse practitioner.

That's because when it comes to primary care there is a critical shortage of physicians. The nurses are much in demand. They are seeking more independence away from the watchful eye of the doctor to get their work done.

Now we've previously discussed a shortage in primary care physicians and now we're turning our focus to the other side of the question and potential solution. Here with us with Kenneth Miller. He is director of the School of Nursing for the University of Delaware. He was also an independent nurse practitioner in New Mexico. He's also past president of the American College of Nurse Practitioners and currently the group's treasurer. Welcome. Thank you so much for joining us.

Dr. KENNETH MILLER (School of Nursing Director, University of Delaware): Thank you for having me.

MARTIN: So I think many people, probably most people know what a nurse is. So what's the difference between a nurse and a nurse practitioner?

Dr. MILLER: A nurse practitioner is actually a registered nurse who has had advanced education and advanced clinical training. And the purpose of using those practitioners is so they can do acute and chronic care. If you look at the data that we have out there, there are approximately 55 percent of the practitioners that are turned out every year are family nurse practitioners. And we're turning out 3.5 times as many family nurse practitioners as the physicians are turning out family practice docs.

MARTIN: So tell me how you - why were you attracted to this field, if you don't mind?

Dr. MILLER: I was attracted to it simply because of the autonomy and because I wanted to work directly with patients and be able to assess patients, be able to diagnose, be able to treat and to prescribe.

MARTIN: And now what is it that nurse practitioners are seeking in the way of more what is it, more recognition? More autonomy what?

Dr. MILLER: I think it's a combination of things. I think most of them want more autonomy. I think there are 28 states this year that are going in for enhancing their scope of practice.

One of the things that we have shown ever since the practitioner movement began back in the 1970s and 1960s is the fact that nurse practitioners can provide quality care at a convenient place and at a price that is equal to what docs (unintelligible).

The other issue associated with that is that all the studies have shown that nurse practitioners perform as well as or in some cases better than family practice docs.

MARTIN: What's the argument against this? Is that it would be confusing? Is that the training is simply not the same? It's just simply not as rigorous?

Dr. MILLER: The training is we have an additional two years after a baccalaureate degree, so there's additional two years in terms of the field that we go into. I think with any type of health care provider, one of the things that you have to look at is what are they going to be the outcomes from what they're doing? All the outcome data shows that we're equivalent to or equal to what the family practice docs are doing.

MARTIN: But I think one argument would be, that two years of post-baccalaureate education can't compare to four years of medical school, so how could they be comparable?

Dr. MILLER: Actually it can because we have four years of nursing, basic nursing education, then we have an additional two years at the masters level. And with the new doctorate of nursing practice program that's out there, those programs can go anywhere from two to five years in length.

MARTIN: The other issue, and I don't know how significant an issue this is for you and for other members of your profession, is that you have a doctorate. And some people call people with a doctorate a doctor as a matter of course. You know, it's a style issue for some news organizations.

For example, at NPR the style we only use doctor for medical doctors per se with an MD degree. That's, you know, it's one of those issues. But and some people, you know, like that and some people don't feel strongly about it. But do you feel strongly about being called doctor? Is that something that you feel is appropriate and necessary? Is that a big bone of contention for you?

Dr. MILLER: For me, personally, it is not. When I go and introduce myself, I always introduce myself as I'm Ken Miller, I'm a nurse practitioner. I think there are some instances, and if you look back at the history, doctor has been used by many, many different disciplines. First in academia many years ago. You have dentists who used it. You have pharmacists who use it. You have veterinarians who use it. And nobody ever confuses any of those roles.

So I think what I have seen most nurse practitioners do is they'll go in and say, hi, my name is Dr. Ken Miller. I'm a family nurse practitioner. And that kind of differentiates it right there.

MARTIN: And how we only have about a minute left. So, Dr. Miller, how is this issue going? As we know, this whole question of how patients will be cared for particularly given this new health care legislation and whether there'll be enough physicians to treat them is a very present and pressing issue. Where is this issue going?

Dr. MILLER: I think the issue is going to be resolved because I think in the next three to five years, nurse practitioners are going to be the gateway for primary care in this country.

MARTIN: Kenneth Miller is treasurer of the American College of Nurse Practitioners. He's director of the School of Nursing for the University of Delaware. He has a doctorate as we mentioned. And he was kind enough to join us here in our Washington, D.C. studio. Keep us posted, if you would. Thank you so much for joining us.

Dr. MILLER: Okay. Thank you.

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