The article below was written by Kathleen Bartholomew, RN, MN, who is one the most popular guest writers for Cracking Health Costs. In this artifice she describes the coming shortage of primary care doctors and how nurse practitioners are well suited to fill in many of the gaps.
NURSE PRACTITIONERS: The Time Bluff by Kathleen Bartholomew
Anyone I’ve ever met who has been treated by a Nurse Practitioner is extremely happy with the care they have received. And as a nurse, I’ve heard numerous stories from family and friends that all drop a reference about the amount of time that an NP spends with a patients vs. the typical physician interaction. Is this observation Reality or Perception?
The vast majority of studies about Nurse Practitioners come from the UK and are a decade old. Even then, the last study which involved time amounted to four minutes more with an NP. But a lot has happened in the last decade in America. What do we know?
“Patients now spend more time with physicians, not less, than they did 20 years ago. The average length of visit to a physician in 2006 was 21.8 minutes; in 2002, it was 18.4 minutes and in 1989 it was 15.9 minutes”(1) Yet people constantly state that doctors are spending less time.
The autonomy that NP’s have today has allowed many to spend the amount of time they deem needed with their patients- especially in hospice, oncology and palliative care or when working closely with a physician partner. But there are also just as many NP’s who have watched the amount of time they have spent with patients steadily decline with each year.
Melanie is an NP who used to spend 45 minutes with each patient. Now, she laments, “The corporate expectation is 20 minutes, but in reality, I spend 15 minutes charting and only 5 minutes hand’s on.” The clinic in which she works needed to ramp up their efficiency in order to generate more revenue – yet patient satisfaction remains high and these patients keep returning for their five minute encounter. Anecdotal? Hardly. She works in one of 600 clinics. What is going on here?
Is the time an NP spends with a patient relevant if the outcomes are par? In our culture, time is equated with caring. Patients feel that NP’s care about them for a few very good reasons.
Physician training has not changed significantly over the years- education has been historically diagnostic and focused on treating symptoms. What is the problem and how can we fix it? With the increase in chronic disease, obesity and diabetes, diagnoses is more challenging than ever. This is not to say that physicians do not care! It’s just that the mental model from which they practice asks for facts more than circumstance, and data more than story. The result? Patient’s perceive NP’s care more and that equates to spending more time with them whether fact or fantasy.
NP’s have a broader theoretical framework based on caring that emphasizes relationships, wellness, and discovering the cause of illness. The words chosen and manner in which an NP asks questions are founded in holistic nursing principles. Why do you think your blood pressure has gone up lately? Last time I saw you, you were worried about your daughter – how is she? The perception from the patients POV (point of view) is that NP’s care because their words validate context, relationships, and thereby demonstrate caring.
There will be a shortage of 60,000 primary doctors by 2025. We need more research for both NP’s and Physicians so that we can both learn how to best help our patients change their behaviors. Perceptions not need match reality, but the current perception gives NP’s the upper hand.
1. (National Ambulatory Medical Care Survey, CDC’s National Center for Health Statistics.)