March 25, 2013

Nurses campaign for broader authority

Thousands of nurses could set up primary-care practices similar to those run by doctors.

By N.C. AIZENMAN The Washington Post

(Continued from page 1)

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Nurse practitioner Karen Millett examines a patient at her home office in Chevy Chase, Md. Many states may take another look at granting nurse practitioners the authority to do essentially everything a primary care doctor does.

Linda Davidson/The Washington Post

Physicians must get a bachelor's degree that typically includes various science courses, then spend four years in medical school, followed by at least another three years in a residency program.


That extra training means family doctors are equipped to recognize unusual circumstances that nurse practitioners might miss, said Reid Blackwelder, president-elect of the American Academy of Family Physicians.

Whether confronted with a patient whose repeated respiratory infections are actually a symptom of HIV-infection or someone with multiple conditions such as hypertension, lung disease and diabetes who comes in with a cough that could indicate a vast range of complications, "the family physician simply has the ideal training to take a patient with vague symptoms, look for the big picture and know what's the best thing to do," he said.

Nurse practitioners say they are eager to work in teams with physicians but that this is impractical where doctors are in short supply, such as rural and low-income communities. And they contend their training, which emphasizes a holistic approach, makes them just as capable as doctors in catching problems.

"We've diagnosed breast cancer here, ovarian cancer, prostate cancer," said Erin Bagshaw, who runs Northwest Nurse Practitioner Associates in the District. "We've seen leukemia, severe heart disease, diabetes. We've handled emergencies where patients were having a pulmonary embolism and had to go straight to the ER. ... There's this fallacy that nurse practitioners can only deal with simple, uncomplicated problems, and it's just not the case."

In Maryland, nurse practitioner Karen Millett has carved out a niche serving working-poor Latino immigrants from nearby low-income enclaves through a private practice she runs out of of her Chevy Chase home.

On a recent morning, Millett's tiny waiting room was filled with the sort of patients who flock to primary-care practices: a woman struggling with obesity there to check the progress of her weight-loss program; a woman in for her annual Pap smear and physical; a woman seeking treatment for an ovarian cyst and uterine fibroids.

To accommodate patients who can't afford to take time off from their jobs, Millett offers extended Saturday hours. Unlike many private physicians, she accepts new Medicaid patients. And for the many who are uninsured, she charges a flat fee of $49 per visit, well below what most primary-care doctors charge.

But to cover her expenses, she has had to make difficult choices. She supplements her income with work at a hospital every other week, and she has not hired any support staff.

"I do everything, she said, "the booking, the payments -- I even clean the bathroom."


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