PORTLAND — In a MaineHealth presentation to the Cumberland County legislative delegation in January, it was made clear, as it is on Maine Medical Center’s website, that Maine continues to face a shortage of primary care providers per capita to deliver what the state needs for good health.

What was not mentioned in the January presentation — and what is missing from MMC’s website — is the role and asset of the nurse practitioner in solving the primary care provider shortage issue.

In both salary and education, according to the 2009 National Salary and Workplace Survey of Nurse Practitioners, family nurse practitioners made almost exactly half the average annual salary of a family practice physician, on average $86,520.

The New England Journal of Medicine reported in December that broadening the scope of the nurse practice is the fastest and least expensive way to address the primary care shortage.

The journal found that “between three and 12 nurse practitioners can be educated for the cost of one doctor.” In the economy we all are experiencing, and with good fiscal reason, these opportunities cannot be overlooked or down-played.

With a short search on any database containing major peer-reviewed journals, one can easily find study upon study showing the quality of care provided by a nurse practitioner is on par if not better than that of the physician.


One such study reported in 2010 was the Veterans’ Perceptions of Care by Nurse Practitioners, Physician Assistants, and Physicians: A Comparison From Satisfaction Surveys. With more than 1.6 million participants, the study’s authors report: “Respondents were more satisfied with services provided by nurse practitioners because they paid attention to the patient’s educational needs, met those needs, individualized care, and listened actively.”

A well-known study by Avorn and colleagues published in the Archives of Internal Medicine showed, in comparison to nurse practitioners, the physician was more likely to prescribe a medication without seeking the relevant history.

Nurse practitioners, in contrast, asked more questions, obtained a complete history, and were less likely to recommend prescription medication. This study suggests that nurse practitioner-delivered care may be superior to that of physicians when a diagnosis is history-dependent.

In light of this evidence, a divide should not be widened or exacerbated between the nurse practitioners and physicians. Each has a definite role in Maine’s health-care system. With MaineHealth’s acknowledgement of the quality nurse practitioners deliver, collaboration and mutual respect can and should be the standard.

MaineHealth and MMC are approaching the issue with Tufts Medical School’s help by trying to increase the amount of physicians practicing in the state.

They have jointly created an MMC — Tufts School of Medicine degree program where the majority of the slots per year (20 out of 36) are for Maine residents.


The hope, as stated on the MMC website, is that Maine residents will set up practice in the state. The solutions they have offered fall short of addressing underlying issues such as cost and quality while increasing the number of primary care practitioners.

MaineHealth must be a part of the solution. Maine law gives the nurse practitioner the autonomy to practice independently.

If Maine is to decrease the primary care provider shortage, our major institutions need to promote that independent practice by increasing the nurse practitioner’s role in their primary provider mix.

The nurse practitioner saves money and provides the highest quality care.


– Special to The Press Herald


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