Managed Care


What NPs Have to Offer Is Real, if Not Concrete

MANAGED CARE August 2000. © MediMedia USA

What NPs Have to Offer Is Real, if Not Concrete

John A. Marcille
MANAGED CARE August 2000. ©2000 MediMedia USA

John A. Marcille

In the mid-1980s, when Senior Editor Frank Diamond was working for a newspaper, he wrote a profile of a local caricaturist. As part of the interview, the subject rendered an outsized version in ink of Frank. The picture shows the cub reporter sporting a huge smile, pencil tucked behind his ear, running toward a typewriter. Frank thanked the man. He didn't point out that he used a computer and, in fact, had never used a typewriter in his writing career.

As a former newspaperman who's actually old enough to remember banging out stories on Smith-Coronas, I have to smile. Words and symbols we use often outlive their usefulness in the real world. When's the last time you "dialed" a phone number?

This brings us to our cover. You will be forgiven if you were somewhat taken aback by the rendering of the nurse's cap. When was the last time you saw that? And yet, as a symbol, it resonates.

There's also a reflector. We all know that means physicians. Those with a critical bent may point out that the cover art misses the point of Frank's story on nurse practitioners because it features no symbol representing them. Actually, it features two. The fact that NPs can be identified with both the cap and reflector without having a symbol to call all their own is why they've been described as the "invisible provider."

NPs are fast becoming visible. They may be a contributor to premium stability for HMOs, because they can lower group practices' cost of providing care. They're a source of irritation to physicians as NPs gain authority to practice independently.

The AMA sees this as a threat to quality, but are doctors really needed to render all primary care? Would their skills be put to better use tackling difficult cases? This isn't to suggest that NPs are equal to physicians. We think, however, that just as primary care physicians know when to call in a specialist, likewise NPs realize the kinds of cases they can't handle.

In five years, if we decide to revisit the status of NPs, we may very well put a symbol on our cover that is theirs alone.


4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
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Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014
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