The idea of advanced practice nurses directing primary care practices on their own without a physician on staff has been a hot topic of discussion lately among the healthcare and public policy communities. The rationale behind most of these proposals stems from the U.S. shortage of primary care physicians. So is substituting nurse practitioners for doctors the answer?

According to an article published in the July issue of Medical Care, the number of NPs could grow by 94% by the year 2025, and they will likely provide increasingly more healthcare services as demand rises during implementation of the Affordable Care Act.

The move toward nurses practicing independent of physicians is coming at a time when medical practice itself is evolving into an integrated, team-based approach that includes physicians and other health professionals, according to the AAFP. This approach is generally known as the patient-centered medical home (PCMH). Studies show the ideal practice ratio of NPs to physicians is approximately 4 to 1. PCMHs built around that ratio provide patients with a primary care doctor and the benefits of team-based care.

Successfully piloted in several locations, the PCMH model facilitates improved primary care and will likely become a reality for most Americans in some form in the next decade. The medical home is a team-based approach to healthcare touted by reformers for its potential to improve quality while lowering costs.

The AAFP report, released yesterday, said that although NPs are valuable members of the medical home team, they are not qualified to head the “household.” It notes that family physicians receive 11 years of college and graduate-level education, including residencies, compared with from 5.5 to 7 years of schooling for NPs.

“Granting independent practice to NPs would be creating 2 classes of care, one with physician-led teams and one guided by less-qualified health professionals,” Roland Goertz, MD, chair of the AAFP board of directors, said at a press conference yesterday. “Americans should not be forced into this 2-tiered scenario. Everyone deserves to be under the care of a physician.”

Physician’s Weekly wants to know… do you agree with the AAFP?