Nurse Practitioners May Offer Solutions in Industry Reforms

Article excerpt

Steve Sternberg

Cox News Service

WASHINGTON _ In Tucson, Ariz., nurses care for 15,000 elderly people through clinics in trailer parks and apartments. In Ocala, Fla., nurses paid by two hospitals treat 14,607 indigents. In Atlanta, patients visiting Grady Memorial Hospital clinics will be treated by nurses, not medical doctors.

They are specialists, known as nurse practitioners, who train for two years after nursing school so that they can diagnose and treat uncomplicated forms of such illnesses as hypertension or diabetes.

Many hospitals and clinics began using primary-care nurses more than a decade ago to cut costs. Now America wants to cut costs, and leading health reform advocates view nurse practitioners as one solution to the nation's toughest health delivery problems: high prices and a shortage of primary-care physicians, particularly in rural areas and inner cities.

"We have between 50 and 60 nurse practitioners at Grady, in our satellite clinics," said Sue McConnell, a nurse practitioner at Grady Memorial's outpatient psychiatric clinic in Atlanta. "In the diabetes clinic, all our patients are seen by nurse practitioners. The medical clinic has five nurse practitioners with stable caseloads."

McConnell, whose patients are largely black, indigent, inner-city residents, has worked in several of the clinics since she joined the hospital in 1978. She regularly diagnoses and treats hypertension, high cholesterol, diabetes, infection and bronchitis. When she's confronted with a patient suffering from dementia, she must determine whether the condition is a byproduct of thyroid disease or advanced syphilis.

Few patients at the clinic complain when they discover that their primary-care provider is a nurse.

"It would be very rare for a patient to say, `I won't talk to you, I must talk with a doctor,' " McConnell said. "Very quickly, they get the idea that this is a person who is going to be able to help them with their problem."

The American Nursing Association estimates that 400,000 of the nation's 2.1 million registered nurses are already delivering primary care, some for high-quality health maintenance organizations, which profit by keeping treatment costs low. "In the future," one slogan goes, "your family doctor may be a nurse."

Also, more than 25,000 physician assistants nationwide practice in virtually every health care setting and in every specialty _ including surgery, according to the American Academy of Family Physicians.

Architects of the Clinton Administration's health reform plan say they view these health workers as a way to cut costs while expanding access to care. First lady Hillary Rodham Clinton has emphasized the administration's desire to expand the role of nurses under the new plan, which is scheduled for release in September.

"We have every indication from the President and Mrs. Clinton that there is much more that nurses could do than state regulations allow," said Virginia Trotter Betts, president of the American Nurses Association.

"If they bring 37 million uninsured into the medical system, there will be too much work, for every group of providers, to let archaic regulations limit the scope of our practice," Betts said.

Doctors, predictably, disagree.

Dr. Daniel Johnson, a trustee for the American Medical Association, said "neither they nor anyone else should be able to practice medicine independent of supervision of a physician."

"The nurse simply does not have the education to do that," he said. "To compare the capabilities of a nurse who has four years' education with someone who has 11 to 20 years of education simply doesn't compute. It's not a question of turf _ it's a question of quality of care."

"It's politics and it's turf," countered Arthur Caplan, a medical ethicist at the University of Minnesota, who was a member of the White House health reform task force. …