Primary Care vs. Nurse Practitioners and Specialists

Brian Klepper comments on the American Academy of Family Physicians’ recent moves to knock down the idea that nurse practitioners are equivalent to physicians for primary care. He mainly concedes their point –after all family physicians have about quadruple the training of NPs– but he’s surprised that AAFP is training its sights on NPs rather than specialists.

In particular, he notes that while NPs are unlikely to take over a central role in primary care, specialists are already doing so. He has some theories for why this may be so:

Primary care is “demoralized and insecure” and therefore acting like a bully beating up the weaker nurses rather than the tougher specialists
Primary care’s leaders have “failed to compellingly convey primary care’s value” and “been meek in defining models that can drive efficiencies”

These are fair points. But there are others that deserve mention. In particular:

At least in urban centers, many primary care docs are quick to refer to specialists cases that maybe they should handle themselves. If that’s the case, patients logically try to save time by going to the specialist directly
Some primary care docs and specialists communicate well, but others neglect care coordination. Therefore it can make sense for a patient to get most of their care from one physician rather than having to act as the coordinator and patient
A lot of primary care offices are rush rush. They may have to be because reimbursement is paltry. (Not only that but patients may be shunted to NPs or PAs against their will anyway.) Meanwhile, certain specialists have a lot more time for patients and choose to devote that time to really listening and counseling. This can be especially true of specialties that make plenty of money doing procedures and can afford to spend quality time with patients if they want