Patient Power: 'Above and beyond Just Doctoring': In an Age of Assembly-Line Care, Nurse Practitioners Take Time to Listen to Patients and Counsel Them
Guglielmo, Wayne, Newsweek
There's no shortage of doctors in Pittsburgh. And with her good health coverage, Meredith Wills could see almost any of them. But the 25-year-old law-school grad prefers to visit nurse practitioner Mona Counts in Mt. Morris, Pa., a 55-mile drive south. Wills has nothing against doctors. She simply likes Counts's combination of medical skills and down-to-earth manner. She likes them so much, she's even willing to pay Counts out of pocket. "Mona has this way of observing the overall person in front of her," says Wills, whose fiance, himself a former nurse, introduced her to the NP eight years ago. "Three years ago my mom had open-heart surgery, and I was in my first year of law school," Wills recalls. "Every time I visited her office, Mona always remembered to ask about my mom. I think it's because she knew my mom's health affected my health. Even now, Mona goes well above and beyond just doctoring."
The appeal of NPs as primary-care providers isn't hard to fathom. Well schooled in medicine, they also possess the kind of nurturing and educational skills that too many doctors lack. In an age of assembly-line medicine, NPs take time with patients, listening and counseling in equal measures. It's that unhurried style that makes them popular with patients--and extremely valuable to doctors harried by managed-care systems. According to the American Academy of Nurse Practitioners, more than a quarter of the nation's 80,000 NPs work in doctor-run solo and group practices. An additional 10 percent or so captain their own practices. And the rest work in places like hospitals, community health centers, nursing homes and home health agencies.
Popular as NPs are, however, some doctors feel threatened. Under pressure from organized medicine, 10 states still require doctor supervision of NPs and other advanced practice nurses, including nurse midwives, nurse anesthetists and clinical nurse specialists. Most of the remaining states insist on collaboration (close or frequent consultation), but not supervision. The paternalism stings. "I've found that competent physicians don't have a problem with NPs," says Mona Counts. "It's the marginalized ones that do."
Before you select an NP for your primary care, here are a few things to keep in mind:
First, unless you're willing to dig into your own pocket, determine whether your health insurer pays for NP services. Fortunately, more and more health plans are starting to include NPs and other APNs on their list of providers. Be cautious, though. Some plans include NPs in their networks as specialists. In such cases, you'll need to see a primary-care physician before being allowed to see an NP provider. …