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Nurse practitioner role debated by AAFP, AANP


Nurse practitioners do not belong at the helm of Patient-Centered Medical Home and should not be permitted to operate independent of physicians, states a new report from the American Academy of Family Physicians. The American Academy of Nurse Practitioners disagrees.

Would allowing nurse practitioners (NPs) to provide medical care without a physician present be an answer to the primary care physician shortage in the United States, or would doing so create a two-tiered system of patient care? It depends on whom you ask.

On one hand, the American Academy of Family Physicians (AAFP) has issued a report stating that such an approach would “splinter” care and not produce the cost savings that some believe it would. The American Academy of Nurse Practitioners (AANP), however, has issued a statement disagreeing with that contention.

Sixteen states and the nation's capital allow NPs to practice without physician involvement, according to the AANP, and several more states are considering such laws.

But on a national level, “[g]ranting independent practice to [NPs] would be creating two classes of care: one run by a physician-led team and one run by less-qualified health professionals," according to the AAFP’s report, “Primary Care for the 21st Century.” Americans should not be forced into this two-tiered scenario. Everyone deserves to be under the care of a doctor."

The AAFP notes that shortages of nurses and NPs exist as well and states that although NPs are a “vital part of the healthcare system,” they cannot fully fulfill the need for a fully trained physicians. “[NPs] do not have the substance of doctor training or the length of clinical experience required to be doctors,” according to the report.

The AANP, however, says that the AAFP report is a misdirected attempt at linking NP licensure to the evolution of models of care. The AAFP’s position is “directly contrary to the recommendations of the Institute of Medicine and the National Council of State Boards of Nursing," the AANP says.

“More than 100 studies analyzing care provided by both [NPs] and physicians have demonstrated that [NPs] have the same or better patient outcomes when compared [with] physicians. Making full use of the [NP] workforce is a critical piece of a multi-pronged solution to address the urgent need for healthcare access in our nation,” AANP President Angela Golden, DNP, RN, FNP-BC, FAANP, said in a statement about the AAFP report. “The ongoing attempts by the AAFP to limit the ability of [NPs] to practice the full extent of their education and training only services to increase the already overwhelming hardships placed on million of Americans who are struggling to gain access to high quality healthcare.”

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