Dean's Message - November 1, 2009
We are bombarded daily by the latest news on healthcare reform. The debate rages on and it is truly anyone’s guess regarding the final outcome.
No matter how heated the political debate has become, there are at least two good things that have resulted from the discussions, including: (1) the recognition of the spiraling shortage of primary care providers in the U.S., and (2) the acknowledgement that nurse practitioners (NPs) can play a key role in reducing the shortage and enhancing access to quality healthcare services.The primary care provider statistics are daunting. A University of Missouri-Columbia and Health and Human Services study in 2008 predicts a shortage of 35,000-44,000 primary care physicians by 2025. An American Academy of Family Physicians 2008 report forecasts a shortfall of 40,000 general practitioners by 2020. Finally, the Association of American Medical Colleges predicts a shortage of 124,000 of all doctors by 2025.
These shortage forecasts are likely to become reality due to the lack of medical students currently entering family medicine. In 2008, only 2 percent of medical students planned to enter family practice compared to 14 percent in 2000, in large part due to substantially higher salaries for specialists versus primary care providers. The Robert Graham Center and National Association of Community Health Centers estimate that more than 15,500 primary care providers would be needed to serve 30 million new patients.
People often ask me: “What do we do as a nation that spent $2.4 trillion on healthcare last year?” and “Who will treat the millions of uninsured patients if universal healthcare is adopted?” My answer is that we can improve this situation dramatically with greater use of nurse practitioners in our healthcare system.
The 145,000 nurse practitioners in the nation provide quality care comparable to physicians, according to patient surveys and the American College of Physicians. Approximately 80,000 nurse practitioners practice in primary care settings and place emphasis on health promotion and chronic disease risk reduction, which is vital in an era where the number 1 killer of Americans is their behaviors (e.g., smoking, overeating, lack of physical activity), which leads to morbidities such as obesity, hypertension, and cardiovascular disease.
Twenty percent of NPs practice in remote or underserved areas of the U.S. Their malpractice rates also are less than 1.5 percent. Nurse practitioners are the fastest growing segment of the healthcare workforce. Even with a new requirement that NPs be doctorally prepared by 2015, they can enter practice in 6 to 7 years compared to 8 to 12 years for physicians.
One of the least expensive reforms we can make in our healthcare system is to empower nurse practitioners to play a leading role in providing primary care, including serving as directors of healthcare homes. However, barriers to NP practice must be removed in all states. For example, nurse practitioners only have full or independent practice authority in 22 states and the District of Columbia. The remaining states must change their regulations to grant the same authority. In addition, insurers in many states reimburse NPs at a lower rate than what primary care physicians receive for the same services. Parity on reimbursement is critical for NPs to be able to establish independent practices that will ensure greater access to healthcare for Americans. Lastly, an increase in Federal and state funding for education programs to attract and increase faculty for the nation’s 343 NP programs is needed in order to prepare nurse practitioners to meet the need for more primary care providers.
At ASU, with the highest enrollment that we have ever had in our NP educational programs, we are doing our part to increase the number of NPs who will provide the highest quality of evidence-based healthcare services to the public. In addition, our five NP managed health centers provide outstanding educational sites for our students and deliver quality care to nearly 7,000 patients on an annual basis, many of whom would not receive care if it were not for our clinics. With support from United Healthcare, we also are launching a new Southwest Health Center for the Prevention and Treatment of Child and Adolescent Depression and Anxiety Disorders, which you will read about in this edition of our new Innovations in Nursing and Health magazine. With one out of four children having a mental health disorder and less than 25 percent receiving any treatment, we must do more to provide access to badly needed mental health services for both children and adults.
The recent merger of the departments of exercise/wellness and nutrition along with health sciences programs into our college provides us with a tremendous opportunity to “walk the talk” of inter-professional education and transdisciplinary collaboration, which has been a hot national topic and touted as a necessity for teamwork and collaborative decision-making, critical strategies to achieve safe, high quality care across healthcare settings.
Our faculty and staff are excited about all of the new opportunities that this merger provides to enhance our educational programs along with our cutting-edge research and clinical practice initiatives. We are continually asking ourselves, “What can we do in the next five years if we know we cannot fail?", which fuels even bigger dreams and more innovations.
A new era has dawned for the ASU College of Nursing and Health Innovation. We have a new marquee building—our faculty, staff and students are energized—our extramural grant funding has reached record levels —and our new 2010-2015 strategic plan is nearing completion. Our future is indeed bright. The keys to our college’s many successes are our ability to stay focused on our innovative dreams, a continued willingness to take risks to discover solutions, and being able to persevere until those dreams are delivered.
Fond Regards,
Bernadette Mazurek Melnyk, PhD, RN, CPNP/PMHNP, FNAP, FAAN
Dean and Distinguished Foundation Professor in Nursing
