AAFP prevails in efforts to clarify difference between physicians and ‘Dr. Nurse’
By Barbara Bein
A recent meeting between the AAFP and members of the National Board of Medical Examiners, or NBME, resulted in acknowledgment from the NBME that a new certification examination for candidates for the doctorate of nursing practice, or DNP, degree—the so-called “Dr. Nurse”—is in no way equivalent to exams for physician licensure.
Academy leaders and representatives from the AMA, the American College of Osteopathic Family Physicians and the American Osteopathic Association met with NBME Sept. 25 in Philadelphia to discuss concerns about the potential for patient misinterpretation of what the DNP represents.
During the meeting, AAFP President Ted Epperly, M.D., of Boise, Idaho, expressed appreciation for the value of nurses in health care delivery, but said he is concerned that the DNP is creating confusion among the public regarding scope and quality of practice. He pointed out that this confusion could adversely affect the U.S. health care workforce by confusing medical students interested in practicing primary care.
“At a critical time like this, we cannot afford to have the public or medical students confused about what a primary care doctor is or who it is. If DNPs are legitimized as being equivalent to real primary care doctors, the potential impact on medical students choosing primary care physician roles could be deeply affected,” Epperly told AAFP News Now.
The issue arises from an announcement from the NBME last spring that it would work with the Council for the Advancement of Comprehensive Care, or CACC, to develop and administer the first certification examination for DNP graduates. According to the NBME, the exam will be “comparable in content, similar in format and will measure similar competencies and apply similar performance standards as Step 3 of the (United States Medical Licensure Examination) USMLE.” Step 3 of the USMLE examinations provides a final assessment of physicians assuming independent responsibility for delivering general care.
During the meeting with NBME, Epperly made several requests, and the two sides agreed that:
- the NBME will ask the CACC to ensure that individuals who take the DNP certification exam attest that they understand the test is not equivalent to the USMLE Step 3;
- the NBME will ask the CACC to make a public attestation that the DNP exam is not equivalent to physician licensure or USMLE exams; and
- if efforts to expand nurses’ scope of practice occur, the NBME will “step up” and clarify that the DNP exam does not prove (or even remotely suggest) physician equivalency.
National survey predicts growing shortage of primary care physicians
Add one more report to the mounting stack of evidence that primary care in America is in short supply and in danger of becoming even more so if something isn’t done at the state and federal levels. The Physicians’ Foundation recently released a survey of almost 12,000 physicians that reveals “widespread frustration and concern among primary care physicians nationwide,” according to a news release from the organization.
Nearly eight out of 10 physicians polled believe there is a shortage of primary care physicians in the nation. Half of the responding physicians report that they plan to reduce the number of patients they see or stop practicing entirely over the next three years.
“Going into this project we generally knew about the shortage of physicians; what we didn’t know is how much worse it could get over the next few years,” said Lou Goodman, Ph.D., president of the Physicians’ Foundation. “The bottom line is that the person you’ve known as your family doctor could be getting ready to disappear—and there might not be a replacement.”
The foundation, which was founded in 2003 as part of the settlement of a class-action lawsuit between physicians, medical societies and third-party payers, reports that chief among the reasons physicians cited for their frustration is an increase in non-clinical paperwork, difficulty receiving reimbursement and burdensome government regulations.
The survey results illustrate a major obstacle in reforming the nation’s broken health care delivery system. To redesign the U.S. health care system so that it is based on primary care instead of specialty care will require a substantial increase in the primary care physician workforce. However, the number of graduating medical students choosing to enter primary care specialties continues to diminish.
According to a 2008 report by the National Association of Community Health Centers, Robert Graham Center and the George Washington University School of Public Health and Health Services, Texas will need 4,500 additional primary care physicians and other providers by 2015 to care for the state’s underserved population.
In advance of the 81st Texas Legislature, the Texas Primary Care Coalition has recommended that the state strengthen its primary care workforce by improving the state’s loan repayment programs for Texas’ primary care physicians who agree to serve in medically underserved areas, by increasing funding for primary care residency programs, fully funding primary care preceptorship programs, and investing in health information technology for primary care physician practices and residencies. The group is comprised of TAFP, the Texas Pediatric Society and the Texas Chapter of the American College of Physicians Services. To read about these and other recommendations, check out PCC’s new report, “The Primary Solution: Mending Texas’ Fractured Health Care System.”
To read more about the Physicians’ Foundation and view their complete survey, go to www.physiciansfoundation.org.
National Procedures Institute celebrates two decades of procedural training
Twenty years ago, National Procedures Institute held its first procedural training conference, making 2009 a year for celebration. That first event was a colposcopy course in Chicago, and for founder John Pfenninger, M.D., it seems like only yesterday that he, his wife, his children and mother-in-law pulled it off. “The night before we left, we were putting the handouts together in the basement of my office at 1 a.m.,” he said.
Since then, more than 45,000 clinicians have trained with NPI, learning valuable skills to enhance their clinical practice and bring new services to their patients. Over the years, NPI has expanded to offer between 100 and 120 courses nationwide each year on more than 60 topics. In the last two years alone, almost 5,500 clinicians attended NPI courses.
A lot has changed in medicine since 1989, and NPI has kept pace, evolving to meet the needs of physicians as well as the demands of the marketplace. “When we began, people had hardly heard of aesthetic medicine,” Pfenninger said, adding that NPI began offering courses on the subject in the late 1990s. “They’ve become some of the most popular courses.”
Last year, TAFP entered a partnership with the American Academy of Family Physicians and the Society of Teachers of Family Medicine to purchase the company Pfenninger started in his 1,200-square-foot clinic. Pfenninger remains closely involved with the operations of NPI and believes that procedural training for primary care physicians is as relevant today as it ever has been.
“I think what is special about NPI is that we really are dedicated to the physician,” he said. Since its founding, the primary goal of NPI has been to teach primary care physicians how to perform office-based surgical procedures. “I felt that doing procedures provided continuity of care, improved the quality of care, reduced the cost of health care, provided what patients wanted and also helped physicians enjoy the field of medicine more.”
Pfenninger has the relationships and the stories to back up his claims, recounting the time a general internist approached him before a conference in Las Vegas. The internist told Pfenninger not to take offense but that he planned to leave after the morning session on the first day. He’d resolved to quit general medicine and pursue a subspecialty. “At noontime, he told me that he had changed his mind,” Pfenninger said. The internist stayed for the full two-day conference, at the end of which he told Pfenninger if he was able to do these procedures as he’d been taught, he might give general internal medicine a little more time. “After taking seven or eight of our courses, he wrote to me saying that he had decided to stay in internal medicine and that he was having the time of his life.”
For a complete course listing and to register for any of NPI’s conferences in 2009, go to www.NPInstitute.com.
Many small businesses pressured to cut health benefits to stay afloat
More than one in three small business owners said that rising health care costs may cause them to cut portions of health insurance benefits for their employees, according to a survey by the Robert Wood Johnson Foundation. Though these employers recognize that health benefits are essential to retain and attract good employees, they struggle to keep up with unpredictable increases in the cost of providing health insurance. With reform ideas circulating Congress and a new president in office, the survey reports that small business owners show strong support for various policy options such as government-sponsored purchasing pools and a change to the tax structure for employer-sponsored health insurance. Read the full report, “Small Business Owners Say Cutting Health Care Costs, Need for Reform are Top Concerns,” on the Robert Wood Johnson Web site, www.rwjf.org.
Texas ranks 46th in overall health in 2008
Texas sunk nine places to rank 46th healthiest state in the country in America’s Health Rankings 2008, an annual analysis of national health on a state-by-state basis compiled by the United Health Foundation. Though the state showed slight strengths due to low prevalence of smoking and binge drinking, low rate of cancer deaths and moderate infant mortality rate, the high rate of uninsured—nearly 25 percent—continues to weigh heavily on the Texas health care system. In addition, the state score worsened due to limited access to primary care with only 95 primary care physicians per 100,000 population, according to the report. Other challenges come from a high percentage of children in poverty, a high incidence of infectious diseases and a rising prevalence of obesity. See www.americashealthrankings.org for more information on Texas and other states.
Texas receives C in emergency medicine
The state of Texas received a C overall and a ranking of 29th in the nation in the annual Report Card on the State of Emergency Medicine published by the American College of Emergency Physicians. This average was buoyed by an A in healthy medical liability environment but was hampered by an F in access to emergency care. Texas received a B- in quality/patient safety, a D in public health/injury prevention and a D+ in disaster preparedness.
Each year, ACEP analyzes the support that each state and the District of Columbia provide for their emergency care systems. The organization recommends Texas address the “severe lack of physicians, registered nurses and other providers,” increase access to health insurance, provide more funds for disaster preparedness and increase injury prevention programs. Find the full report on www.emreportcard.org.