Dean Bernadette Melnyk Speaks on Nurse Practitioners' Roles in Primary Care

Nurse practitioners could help lessen shortage of primary care physicians

Nurse Practitioners can play a larger role in expanding access to primary healthcare in U.S. health reform if limits to their practice are resolved, according to Dean Bernadette Melnyk of the Arizona State University College of Nursing and Health Innovation. Dr. Melnyk made the remarks in a plenary keynote speech at the Summit on the Future of Primary Care in Rural and Urban American sponsored by the Health Resources and Services Administration (HRSA).

Primary Care Window of Opportunity

Dean Melnyk noted that the total of nurse practitioners in the U.S. has increased 27 percent to 145,000 since 2000 and is one of the few segments of the healthcare workforce that is growing while the total of primary care physicians has declined. “With NP enrollment and graduates up 55 percent since 2004, we have a window of opportunity to strengthen the healthcare workforce,” Dean Melnyk said. “We need to take steps to take advantage of this opportunity at a time it is critically needed.”

According to the Josiah Macy, Jr. Foundation, the number of physicians who practice family or internal medicine has declined 37 percent compared to 50 years ago and only 30 percent of medical students today are choosing to practice in those areas. Only two percent of students currently in medical school who responded to another survey said they planned to enter primary care practice.

Thirty percent of Americans today lack a regular source of primary care and the 70 percent report they cannot obtain same day appointments with their primary care providers. Seventy million Americans, or 23 percent, are un- or under-insured, which further limits access to primary care, Dr. Melnyk added.

Nurse practitioners (NP’s), who are registered nurses prepared with masters and doctoral degrees and provide a wide range of services as well as chronic and acute healthcare, can help to meet primary care needs of Americans.

Solutions Must Be Part of Health Reform

Despite the important role in primary care that NP’s already play, Dean Melnyk said they could make a larger contribution if certain limits were resolved. She listed the barriers as:

• Only 53 percent of managed care insurance providers credential NP’s as primary care providers and provide equal payment to PCP’s.

• Only 22 states and the District of Columbia authorize full or independent practice authority for NP’s.

• Only 12 states and the District of Columbia permit NP’s to have full prescription privileges.

• NP’s are not permitted to serve as directors of Federally Qualified Health Centers.

• NP-managed Health Centers are not included in Centers for Medicare and Medicaid Services demonstration projects to provide data on their patient outcomes.

The ASU dean called for these barriers to be removed, as well as for more funding for NP educational programs by the government and private foundations.

Dean Melnyk is a certified pediatric and psychiatric nurse practitioner. She is one of two nursing leaders who serve on the US Preventive Services Task Force which sets evidence-based screening and behavioral counseling recommendations to guide primary care practice for the nation.  She also has served on the Institute of Medicine’s Healthcare Provider Sector for the Roundtable on Evidence-Based Medicine.

About ASU College of Nursing and Health Innovation

The ASU College of Nursing and Health Innovation is one of the most innovative colleges of nursing and health in the United States. It was ranked in the top eight percent of graduate nursing programs in the nation in the 2008 U.S. News & World Report College Rankings and is the only college of nursing to have integrated health promotion and sciences programs into its curriculum.

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