Managing Editor’s Memo

Nurse Practitioners: Just Where Do They Fit In?

Frank Diamond

This issue we look at the roles that nurses and nurse practitioners play. (And let’s quickly add that both men and women populate the professions—though the majority of both are still overwhelmingly female.)

Nurse practitioners are especially on the managed care radar screen because health plans have to pay them. The overall number has grown from 120,000 in 2007 to 234,000 now. The median pay is just over $100,000 per year.

But not everyone welcomes them, as our story by Jan Greene indicates. Physician groups say that NPs don’t have the necessary training and experience. NPs counter that they can fill a growing need for primary care providers.

But what care they offer depends on what state they practice in. NPs have restricted scope of practice if they have to maintain collaborative agreements with physician practices for practicing and prescribing; reduced if an agreement is needed only for prescribing, and full if no agreement is required. Twenty-two states give NPs full scope of practice authority.

As Greene reports, a recent legislative push in Oklahoma to give NPs more practice authority had gained legislative momentum but was then blocked.

Jean Hausheer, MD, president of the Oklahoma State Medical Association, argues that “there’s a huge difference in how we’re trained. We’ve got to be careful [about allowing] a one-to-one substitute for a medical professional.”

Meanwhile, Tony Pratt-Reid, immediate past president of the Association of Oklahoma Nurse Practitioners, doesn’t understand all the fuss about making sure NPs are properly supervised. “We’re not really supervised now. We have full autonomy to see a patient, diagnose them, and treat them with whatever modality we think is appropriate.”

And what do patients think? Two members of Managed Care’s editorial team recently saw NPs for routine care. One didn’t mind. One wondered why he didn’t get a doctor. That ought to clear things up.


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