New Survey: Physicians, Nurse Practitioners Disagree on Nurses’ Role in Providing Primary Care

By Lori Melichar Gadkari, PhD, MA

Lori Melichar Gadkari, PhD, MA, is a senior program officer at the Robert Wood Johnson Foundation (RWJF), in the Research and Evaluation Unit and the program officer for INQRI.

Yesterday the New England Journal of Medicine published the results of a study co-funded by the Robert Wood Johnson Foundation, Johnson & Johnson, and the Gordon and Betty Moore Foundation. “Perspectives of Physicians and Nurse Practitioners on Primary Care Practice” finds that 96 percent of nurse practitioners and 76 percent of physicians agreed with the Institute of Medicine report recommendation that “nurse practitioners should be able to practice to the full extent of their education and training.” The new study is authored by Karen Donelan, ScD, EdM, Catherine M. DesRoches, DrPH, Robert S. Dittus, MD, MPH, and Peter Buerhaus, PhD, RN.

When asked how increasing the supply of nurse practitioners would potentially affect the United States health care system, the authors found that the majority of physicians (73%) said increasing the supply of primary care nurse practitioners (PCNPs) would lead to improvements in the timeliness of care. A much smaller majority of physicians (52%) said increasing the supply of PCNPs would lead to improvements in access to care for people in the country. 

However, the new survey found significant disagreement between primary care physicians and PCNPs about whether increasing the supply of PCNPs would improve patient safety and the effectiveness of care, and whether it would reduce costs. There was also a large professional divide about proposed changes to PCNPs’ scope of practice, putting PCNPs in leadership roles, and the quality of care that PCNPs provide.

These findings are consistent with the results of an RWJF study conducted within the online Sermo.com community, in which nearly half the physicians surveyed agree that “allowing APRNs [advanced practice registered nurses] to practice independently would increase access to primary care in the U.S.”  In the Sermo study, physicians predicted a decrease in average quality of care provided to patients if all states allowed APRNs to practice independently.

These predictions are not evidence based. In a review of studies comparing the primary care provided by nurse practitioners to the primary care provided by physicians (MDs), researchers found that patients of both groups had comparable health outcomes. Nurse practitioners were found to out-perform MDs in measures of consultation time, patient follow-up, and patient satisfaction. 

The new Donelan study also highlights disagreement between primary care physicians and PCNPs on the clinical services that PCNPs provide. Those who work in collaborative practices with one another indicate that both types of providers perform a wide range of primary care services. But only 23 percent of physicians say that nurse practitioners in their practices provide services to complex patients with multiple conditions, while more than 60 percent of PCNPs say they care for these patients.  

A resource created by RWJF to inform members of the IOM committee shows the overlap in health care services for the two professions. 

The new study in the New England Journal of Medicine is based on a survey mailed to a random sample of 2,000 primary care clinicians; 467 nurse practitioners and 505 physicians responded.