Primary Care Shortage: Whose problem to solve anyway?

I’ll preface this opinion by saying that I was a Registered Nurse (RN) for 15 years followed by 8 years of being a Nurse Practitioner (NP). I love bedside RNs and thoroughly enjoyed my time as an NP on Physician led teams on inpatient units. In reference to the American Association of Nurse Practitioners (AANP) position statement titled “Nurse Practitioners in Primary Care, ”the question must be asked as to if the primary care dilemma outlined in the statement is a NP problem to solve or a Physician/Primary Care Physician’s (PCP)? I do agree with where the position statement states “NPs are a vital part of the U.S. primary care workforce.” Where I disagree with the position statement is in the premise that it is the discipline of nursing’s responsibility to solve the PCP shortage: 

“Evidence supports the high quality and cost effectiveness of NP care and the continued interest of the discipline to contribute to solving the primary care dilemma.”

When did it become ok for one discipline (NPs) to hijack a role of another discipline (MDs) and (1) claim this role to be their own, (2) rename PCP to primary care provider, and (3) claim responsibility to solve the other discipline’s problem. My assertion is that the PCP shortage is a problem for physicians to solve and not a nursing problem to solve. I would further profess that perhaps nursing efforts would be better served if it focused on the bedside RN shortage rooted in quality of life issues for RN’s and a mass exodus of RN’s to NP programs. These programs often of low quality and accepting RN’s with little to no nursing experience. There’s a few old idiom’s that come to mind to illustrate my point: (1) get your own house in order before attempting to clean mine, (2) stay in your own lane, and (3) clean your own side of the street. 

I’m a runner. I love to run. Suppose I started calling myself a marathoner without ever running one. Do I have the right to do so? Does this give me the credibility to give marathon-running advice? I don’t believe so. I have the utmost reverence for nursing both RNs and NPs, but I think the position statement is missing key factors in purporting that:

“The NP scope of practice includes blending nursing and medical services for individuals, families and groups. NPs diagnose and manage acute and chronic conditions and emphasize health promotion and disease prevention.”

The key factors are that as physicians, we were never asked by nursing (1) how we would solve this problem or (2) how we would feel if they took on solving the primary care physician shortage, or (3) how would we feel if NPs came into the MDs lane and started practicing medicine (an MD role). We were never asked and now there is much angst and animosity as MDs are waking up and starting to push back. Not only must MDs now take on powerful nursing lobbies, we must reclaim the primary care/physician shortage problem as our own problem. Owning our own problem will be a key in lessening the impact of other disciplines believing they have to intervene. Let’s get our own house in order and clean our side of the street. 

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Robert Duprey was an NP and will be an official MD in weeks.

Robert Duprey MD

Robert P. Duprey Jr studied medicine as a 2nd career medical student who went to medical school in his 40’s after honorable discharge and ‘retirement’ from 25 years in the US Military (USCG & US Army). He was a registered nurse (RN) with specialty training as a psychiatric RN in the US Army for 15 years. During this time he also became a Master’s level psychotherapist in 2002. While on US Army active duty he also became a Psychiatric Nurse Practitioner while working full time in 2011. He served as a Psych NP on active duty, to include a combat tour in Iraq, until his ‘retirement’ in 2014 and moved to Philippines with his 3 children. At this time he started medical school overseas at Oceania University of Medicine based out of Samoa accredited by Philippine Accrediting Association of Schools, Colleges and Universities (PAASCU). He continued to work as a Psych NP throughout medical school to support his children and to not have to take out loans for medical school tuition. Originally from Rhode Island, he completed medical school clerkship rotations throughout the USA with a graduation in May 2019 earning the esteemed credential of MD. He has successfully completed USMLE Steps 1, 2CS, and 2CK. He will take Step 3 this September as he applies for Psychiatry Residency. Having been and RN, NP and now MD, he is a believer of Physician led multidisciplinary healthcare teams 

  4 comments for “Primary Care Shortage: Whose problem to solve anyway?

  1. Neilly Buckalee
    May 5, 2019 at 12:34 am

    Spot on!

  2. Pat
    April 30, 2019 at 9:12 am

    Nice insights, good piece.

  3. Steve O'
    April 30, 2019 at 8:44 am

    Best wishes to you. If you would enjoy a condensed handbook of medical wisdom, I recommend Clifton Meador’s A Little Book of Doctors’ Rules The original is out of print, but there are subsequent, although perhaps lesser, writings on wisdom.
    In our profession, it is likely that Maimonides was one of the wisest. I have long been in search of his original quote, that medicine is quite easy for those who know little about it. Decisions can be made quickly and with solid certainty. However, the longer one practices medicine and the more patients one sees, the more complex and dense every case becomes, and the humility of the physician ever grows.
    We Americans can sure agree. A member of my extended family is frail and ill, and the closest family members have predicted her demise within 36-48 hours. They have run all the standard tests, and taken x-rays, and that is what everyone seems to agree upon, even the one who have looked it up on the Internet.
    I am the only doctor among the extended family. My practice involves Internal Medicine, principally of the frail elderly, and I am not at all certain that this person will expire, having no mortal illness. My relatives disagree, and pity me for my uncertainty.
    The trend is towards Family Medicine and Medical Homes; but the emphasis is on the Family making decisions on Medicine at Home. The subtle arrogance that we are all massively competent in absolutely all areas of knowledge permeates society.
    We assume that doctors, lawyers, ministers and economists, writers and historians, are all pompous products of the collapsed educational system. Therefore, just given a good search engine, we can generate opinions as sturdy as those of some Stanford quack.
    In medicine, as surely as in other areas, we are rowing the Ship of Fools around in circles. But at least everyone has the right to row. Corporations love it, for if people own their own decisions, they own their own legal liability. The White Ship of Thomas FitzStephen has already set sail.

  4. Eleni Prieto
    April 30, 2019 at 7:16 am

    Wow. Perfect.

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