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The Telegram
  • Nurse practitioners one solution to doctor shortage

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  • Deanna Brady can diagnose and treat illnesses, write prescriptions and educate patients about how to stay healthy.
    But as a nurse practitioner, she blends clinical ability with the softer side of nursing. “We are nurses first so we have that compassion and the bedside manner and the way to talk to patients and the caring aspect. … We look at the patient as Pam, the whole patient, as opposed to Pam — hypertension,” she said.
    Brady started out as a registered nurse, but went back to school to become a nurse practitioner and then a psychiatric nurse practitioner so she could do more for her patients. Now she works in primary care at the Whitesboro office of Adirondack Community Physicians and in mental health at New Hartford Psychiatric Services.
    “I think I have a great rapport with my patients and I think that I help them to make better, healthier decisions,” Brady said.
    The growing and aging population and the Affordable Care Act are expected to increase the demand for health care, leading to a shortage of 52,000 primary care doctors by 2025, according to an Annals of Family Medicine article last year.
    Mid-level practitioners — nurse practitioners, physician assistants and midwives - are expected to pick up some of that slack, especially in places like the Mohawk Valley where doctors are already in somewhat short supply.
    “Nurse practitioners are filling in in a lot of areas,” said Stephen Ferrara, executive director of the Nurse Practitioner Association of New York State. “I’ll be the first to say nurse practitioners are not the only solution to the health care provider shortage, but we present as one of the possible solutions as we look to different models of care and different delivery models in the United States and in New York in particular.”
    How can they do more? Nurse practitioners want to get rid of state requirements that make them work under a written collaborative agreement with a physician. Nurse practitioners working outside doctors’ offices would no longer have to pay for collaboration, and health center hirings wouldn’t be limited by doctor-nurse practitioner ratios. Advocates say that would help draw more nurse practitioners to rural areas and community health centers that serve the poor.
    Legislation making this change has been introduced to the state Legislature before and is expected to be re-introduced in January.
    “My education allows me to assess, diagnose and treat simple and complex problems and yet New York says I can’t do that unless a physician looks over my shoulder. I’m trained to do it. I’m perfectly capable of doing it,” said Brady, who is also vice president of the Nurse Practitioner Association Mohawk Valley Chapter.
    Page 2 of 2 - The Healthcare Association of New York backs the nurse practitioners. But doctors aren’t sold on the idea.
    The issue is quality of care and those concerns haven’t changed since the current rules were enacted in 1987, said Elizabeth Dears, vice president of regulatory and legislative affairs for the Medical Society of the State of New York. “We’re large proponents of the health care team and believe that nurse practitioners should be part of the team and not operating in separate silos,” she added.
    Jean Moore, executive director of the Center for Health Workforce Studies at the University at Albany, wants to see the scope-of-practice bill passed, though, as one way to counterbalance the looming shortage of primary care doctors.
    “I’m not saying we shouldn’t have doctors because we need them and there are certainly things that they are really the best at,” Moore said. “But we need to start handing off more of the routine stuff to people who are trained to do that.”

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