What is holding the Nurse Practitioner role back?
See the original post and podcast episode here.
I absolutely love the Freakonomics podcast because the explanations for people's behavior can often be traced to something involving money (example: my article on mandatory flu vaccines).
So when I saw that Freakonomics did an episode about nursing, I was really excited. Here is what I learned:
The Clip: On the Freakonomics Podcast episode: Nurses to the Rescue
- There was an accidental experiment occurred in Denmark that showed the negative impact of a nursing shortage on patient lives.
- In Denmark, the gov't expanded their parental leave program to offer up to "one year of extra paid leave to every parent with a child age 8 or younger...so parents will receive typically 70% of their previous income and with job security to return to their previous position."
- Sounds nice doesn't it?
- An unexpected outcome occurred in the nursing sector, where a large percentage of the population were female which meant "a lot of nurses took leave".
- "But then there were no unemployed licensed nurses that could replace them".
- The resulting nursing shortage lead to a "21% increase in readmission rates for adults and a 45% increase for newborns"
- All-in, the nursing shortage led to an overall "increase in mortality by 13% among people aged 85 and older."
The Challenges for Nurse Practitioners
Nurses can't practice independently
- In most states, including California, NPs don't have "full-practice authority. Instead, they have to work under the supervision of physicians, who are each limited to overseeing only four NPs".
- "The main argument against allowing NPs to practice independently is that they have less training than physicians. But there’s a mountain of empirical evidence from randomized trials, case studies, systematic reviews, and analyses of malpractice claims in states where similar legislation has already passed that all points to the same thing: when it comes to primary care, NPs are just as safe and effective as doctors"
Why this is stupid (and the data to prove it).
- "Of the roughly 600,000 practicing physicians in the U.S., only about a third of them work in primary care. This shortage is getting worse, as baby-boomer doctors retire, and since fewer than a quarter of newly minted doctors go into primary care. By 2030, the Association of Medical Colleges projects a potential shortage of more than 40,000 primary-care doctors."
- Then "there’s limited capacity at U.S. med schools. Of the 53,000 students who applied for admission in 2016, 32,000 were rejected from all the schools they applied to. That’s sixty percent of all applicants
- "between the residency bottleneck, and the med-school bottleneck, and the very high cost of tuition, you can see why so few new doctors are heading into the relatively low-paying field of primary care"
- In case you're not a huge data-nerd like me. What all of the research above summarizes.
- Shortage of doctors.
- Existing doctors don't want to work in primary care.
- Nurse practitioners provide equal quality of primary care for 1/2 the price.
The villain of the story: The American Medical Association
- Senator Ed Hernandez was interviewed for the podcast episode because he has been fighting "for a bill to free NPs from these constraints."
- When asked why the bill was unsuccessful, Hernandez stated, "Why it didn’t get through? It’s the California Medical Association. It’s the political clout that they have here in the Capitol"
- The episode then provided several other examples of the AMA blocking progress in healthcare which are too frustrating for me to type out. You should definitely listen to the whole episode for that. #Triggerwarning.