By Edgar Wilson
A perfect storm of issues is blurring an already fuzzy-at-best distinction between doctors, nurses, and even pharmacists when it comes to scope of practice. From the need to control costs, to the critical provider shortage, changing roles in health care has definitions and responsibilities transforming.
A New Front in an Old Conflict
The scope of practice controversy itself is nothing new, especially as physicians and nurses compare notes on what they actually do with and for their patients. Studies show that patients are comfortable with NPs and RNs providing primary care, even as the medical community increasingly recognizes nurses as deserving equal footing with physicians, yet the debate has already grown much more complicated.
A key component of the ongoing controversy is demographic, and it has a name: Baby Boomers. The aging of the largest population group in history, combined with longer life expectancy, means there simply aren’t enough physicians or nurses to keep up with the number of people requiring care.
Live Long, and… Suffer?
Given the Baby Boomer situation, of course, it isn’t just the sheer number of patients that complicates things but their advanced age. Geriatric specialties are becoming more and more critical as the share of the population over 60 swells.
Unfortunately, the nursing and physician shortage looks even bleaker through the geriatric lens, as less than one percent of RNs (not even three percent of Advanced Practice RNs) have any certification to care specifically for elderly patients—and only around one third of collegiate programs incorporate any form of geriatric training.
Broadening the Scope
The slow inflation of elderly patient populations comes with a corresponding inflation of complex, chronic, and sometimes rare conditions. In these cases, the already lacking geriatric training is not enough—more specialization and certification is demanded out of nurses and physicians alike.
The issue of scope of practice is no longer just about narrowing what nurses and doctors do in relation to one another, but broadening general scopes to cover much more specialized treatment than they are equipped to deal with.
How Many Doctors Does It Take to Write A Prescription
Of course, part of the reason people are living longer is the proliferation of new, more effective medication. But as more and more people manage chronic conditions with medication, the opportunity for adverse reactions and conflicting prescriptions skyrockets.
This, in part, is why Congress created the requirement in Medicare Part D plans for patients with certain chronic conditions to receive Medication Therapy Management (MTM). This assigns a pharmacist to patients specifically to track their medication, look out for potentially harmful interactions, help them recognize side-effects, and other outpatient service related to medication.
While pharmacists require specialized training to practice, they have not traditionally been seen as primary care providers—now, in some cases at least, it has become law.
An Ounce of Prevention
There is also a massive shift—long sought and hard fought—slowly impacting and transforming how medicine is practiced everywhere. The new emphasis on preventive care, and patient-centered medicine, has, broadly, shifted the emphasis in healthcare from doctors to nurses as primary points of contact for patients.
The structure of the Affordable Care Act emphasizes the role of nurses as leaders in advancing preventive medicine, including funding for NP-led clinics and incentivizing preventive care practices in clinical and other settings. While nurses have philosophically been accepted as preventive care providers, while doctors emphasize problem-solving in their approach, the new emphasis on prevention has seen physician groups emphasizing their role as consultants and leaders.
Despite evidence that empowered nurses can improve care—specifically through preventive medicine methods—physician advocates for the need for physician-led collaboration paint the shift in focus as an existential threat to traditional medical practice.
Growing Out of the Problem
Even in the face of opposition, the trend that has started is more likely to slow down than reverse. In the longer term, what will be interesting to observe is the impact of the Boomer generation aging out of the workforce itself. Of course, retiring healthcare workers are a key element of the shortage itself, since there aren’t enough new doctors and nurses to replace them.
But these same workers on the brink of (or deliberately delaying) retirement also represent the vested interests most resistant to change in healthcare. Already, there is a marked generational difference between older and younger physicians; those entering the medical workforce today are, predictably, much more open to the types of changes that give pause and are met with resistance by more established physicians.
While far from guaranteed, it is possible that as younger generations grow to outnumber Boomers still working in healthcare, there will be an accompanying shift toward acceptance of redefined roles, and increasing autonomy for different types of providers.
Edgar Wilson is an Oregon native with a passion for cooking, trivia, and politics. He studied conflict resolution and international relations at Amherst College, and has split his time between New England and the Pacific Northwest ever since. He has worked in industries ranging from international marketing to broadcast journalism, currently serving as a marketing consultant and blogger. He can be reached via email here or on Twitter @EdgarTwilson.
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