The American Academy of Family Physicians welcomes discussions about primary care as foundational to a true health care system. Approaches must be multi-faceted and team-based at every level. Changes must be made in education, training, health care access and provision, and payment. Solutions focusing mainly on cutting costs or shortcutting training are short-sighted.
Physicians and advanced practice nurses are not interchangeable. Each has roles defined by training and experience. The best quality patient care depends on these critical members functioning efficiently in teams.
Every American needs and deserves a personal physician and nurse. The educational and training differences are profound: advanced practice nurses follow different paths to their degree, completing 2,300 – 5,350 hours of education and clinical training during five to seven years, compared to family physicians’ standardized path of 21,700 hours and 11 years. Family physicians’ additional training brings breadth and depth to the diagnosis and treatment of all health problems, as well as hands-on knowledge of other disciplines, improving coordination of care within systems.
The primary care shortage will grow as more Americans gain insurance coverage under the Affordable Care Act. The answer is not to substitute one team member for another, but to have more doctors and more nurses working together in integrated, coordinated, physician-led health care teams in patient-centered medical homes. This model has proven to increase the quality of care for the patient and cost-effectiveness for the health care system, and it closes the workforce gap.
Family physicians value nurse practitioners. We work with these skilled teammates across the country. We share our vision in our report Primary Care for the 21st Century, which offers a greater perspective on this important issue.