The American Academy of Family Physicians (AAFP) recently released a report emphasizing the importance of a team approach to primary care as we move into the future of medicine, entitled Primary Care for the 21st Century. The report focuses on an approach known as the patient-centered medical home. It also strongly recommends against advanced practice registered nurses (APRNs) practicing independently.
In fact, the report goes into great detail about why APRNs are inferior to family physicians, citing education and training differences. The AAFP states every practice needs physician leadership skills to guide the other providers, recommending a team of non-physician providers supervised by a physician in a 4:1 ratio for ideal practice.
I, too, believe that the best practices are ones where physicians and APRNs work collaboratively. I fully admit there are limits to my knowledge base and diagnostic skills, and I appreciate being able to call on my physician partners when I have a complex clinical question or am unsure of the best patient management plan.
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However, I do not agree with many of the AAFP’s statements about APRNs providing substandard care. APRNs consult or refer patients out to a physician for anything outside of their scope of practice. Isn’t this what most physicians do when they refer patients to specialists? It there really any difference?
In theory a patient-centered medical home is a great model for primary care, but in reality there is a shortage of family physicians in this country, particularly in rural America. APRNs are often the only providers of medical care in these areas.
The AAFP’s report states, “Everyone deserves to be under the care of a doctor.” I’m curious about how the AAFP plans to supply those physicians. Their report did not provide much insight into this particular dilemma.
Sadly, the AAFP’s report does little to provide any real evidence-based answers to the primary care shortage in this country. Instead it seems like a thinly veiled attempt to discredit APRNs as “less qualified health professionals.”
This undermines the strides APRNs have made to fill in the gaps that exist in the American health-care system. Instead of focusing on the aspects that divide U.S. health care providers, national health organizations should encourage collaboration to benefit the patients they serve.
Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.
