Nurse practitioners in primary care.

All rights reserved. Individuals may photocopy all or parts of Position Papers for educational, not-for-profit uses. These papers may not be reproduced for commercial, for-profit use in any form, by any means (electronic, mechanical, xerographic, or other) or held in any information storage or retrieval system without the written permission of the publisher. Anticipated and actual shortages of primary care physicians have led policy-makers to consider the roles of nurse practitioners (NPs) in improving access to primary health care services. Over the past 20 years, an increase in the numbers of NPs, enactment of state laws expanding the scope of practice, prescriptive authority and third-party reimbursement, and national efforts to improve health care access, have resulted in expanded roles for NPs in providing primary care services. Greater autonomy of NPs has been a point of contention between the medical and advanced practice nursing communities. Questions have been raised about the adequacy of NP training and certification, quality of patient outcomes, and perceived intentions to replace primary care physicians. There has also been much controversy concerning the Doctor of Nursing Practice (DNP) degree. While there are differences in the nature and extent of training of physicians and NPs and the scope of practice for NPs varies considerably from state to state, the College acknowledges that NPs are health care professionals with the capability to provide important and critical access to primary care. The American College of Physicians recognizes that NPs and physicians have common goals of providing high-quality, patient-centered care and improving the health status of those they serve. In addition, physicians and NPs share concerns regarding appropriate reimbursement for services provided, especially related to care coordination, and the decline in the primary care workforce. Acknowledging the critical role NPs play in improving access to care, the College offers the following position statements on physicians, NPs, the DNP degree, primary care, and the patient-centered medical home. Position 1: Physicians and nurse practitioners complete training with different levels of knowledge, skills, and abilities that while not equivalent, are complementary. As trained health care professionals, physicians and nurse practitioners share a commitment to providing high-quality care. However, physicians are often the most appropriate health care professional for many patients. A. Whenever possible, the needs and preferences of every patient should be met by the health care professional with the most appropriate skills and training to provide the necessary care. B. Patients with complex …