Politics aside, a recent survey shows that consumers are comfortable visiting a variety of health care professionals for their health care needs. That’s good news
considering the growing shortage of physicians, particularly in primary
care. The annual Deloitte Center for Healthcare Solutions survey of thousands
of consumers shows that people recognize that they can receive quality care
from a variety of licensed and certified health care professionals. About
half of consumers believe that they can receive the same quality primary care
services from a nurse practitioner and other professionals as a physician.
There are about 3400 nurse practitioners in Maryland, most working in primary care, but spanning all areas of healthcare—outpatient, hospital, long-term care,
pediatric, and specialty care. Nurse practitioners are educated and trained to
evaluate patients and make treatment decisions, building on their nursing
education and experience with the expertise to make diagnoses, order tests, and
prescribe medications. Following the RN education and training (Bachelor’s
degree), a nurse enters a Masters or Doctorate level nurse practitioner program
with courses in advanced sciences, pharmacology, and clinical decision making.
Clinical practice hours give practical experience in adult primary care, family
practice, pediatrics, acute care, or psychiatric mental health, depending on
the chosen certification track.
Most nurse practitioners in Maryland work in group practices owned by physicians,
hospitals, and other healthcare groups. Healthgrades.com lists 205 nurse practitioners working in a 10 mile radius including Columbia and Ellicott City.
Although nurse practitioners are prepared to practice independently and have
passed a national certification exam geared toward this independent role,
states vary on the amount of oversight for nurse practitioners. A state law
change in Maryland in 2010 removed a 17+ page collaborative agreement that was required between a physician and a nurse practitioner in order to practice.
Now, a nurse practitioner must submit the name of at least one physician to the
Board of Nursing that he or she agrees to consult with and refer to; and the
nurse practitioner must attest to following a nationally-recognized set of
standards of practice.
Despite the law change, regulatory barriers still exist. On the state level, many
insurance companies do not credential and pay nurse practitioners directly for
their services. On the national level, Medicare laws leave nurse practitioners
out of some very basic tasks. For instance, a physician’s signature is required
on home health and hospice care orders as well as certificates of medical
necessity for medical equipment. In reality, nurse practitioners are
seeing the patients regularly, assessing their needs, and have the expertise to
determine what services they need.
How does this affect access to care in Maryland? According to Shannon Idzik,
President of the Nurse Practitioner Association of Maryland, “We are fortunate
to have a growing number of nurse practitioners here in Maryland, thanks to our
universities. With greater recognition of the NP role by consumers, insurance
companies, and the entire health care community, we can create a climate that
eliminates practice barriers beyond 2014 when an estimated 300,000 people will
gain insurance in Maryland. NPs will be here to provide high-quality,
comprehensive, and cost-effective care through a unique model that combines
nursing and medicine. Nurse practitioner care is holistic, patient-centered,
prevention oriented, and geared toward improving health outcomes.”