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NY's nurse practitioners want to fill void

Jeanne Martin, a nurse practitioner, speaks with a

Jeanne Martin, a nurse practitioner, speaks with a colleague at a nursing station at Stony Brook University Hospital. (March 14, 2013) Photo Credit: Daniel Brennan

Nurse practitioners say they can fill the void created by a shortage of primary care physicians, but they first want to ensure that New York legislators lift the state's restrictions on their profession.

Physicians who practice family medicine, pediatrics and internal medicine are in the minority among doctors statewide, data show.

Nationally, almost half of the nation's 830,000 doctors are over age 50 and may retire in the not-too-distant future, according to a 2012 report from the Physicians Foundation. The Association of American Medical Colleges estimates a shortfall of 130,000 physicians by 2025.

"Nurse practitioners can definitely fill the gap, that's one of the reasons we want to shine a light on nurse practitioners," said Jeanne Martin, a nurse practitioner at Stony Brook University Hospital and president of the Nurse Practitioner Association New York State.

"We are educating more and more nurse practitioners and they are trained in primary care," Martin said. At the very minimum, she said, nurse practitioners have a master's degree and many hold a doctorate.

Yet, Martin describes advanced-practice nurses as being "shackled" by regulations.

Currently, nurse practitioners in New York must have a state-mandated collaborative relationship with a physician, who oversees the nurse's practice, Martin explained.

"There are a lot of artificial barriers that are holding us down," Martin said.

Stephen Ferrara, interim executive director of the nurse practitioners' association, said at least 18 states have banished restrictions on nurse practitioners -- and it's time New York followed suit.

"A lot of nurse practitioners have desires to open their own practices," said Ferrara, who heads the occupational health division at Montefiore Medical Center in the Bronx, where he treats sick employees.

It would be easier to hang out a shingle, Ferrara said, without having to sign a collaborative agreement.

The nurses were encouraged when Gov. Andrew Cuomo mentioned during his State of the State address a pending bill in the Assembly that would lift practice restrictions on them.

But Ferrara bemoaned the lack of similar legislation in the Senate.

Doctors insist if nurses want to practice medicine they should apply to medical school.

"There is a huge disparity in training between nurse practitioners and physicians," said Dr. Robert Hughes, president of the Medical Society of the State of New York.

"I understand that they want to eliminate the collaborative agreement," Hughes said. "But there are consequences for the public if that happens."

Hughes said the public has been led to believe the training for nurse practitioners and physicians is comparable, but nothing could be further from the truth.

Ferrara, who holds a doctorate, said the additional study for advanced nursing doesn't emphasize courses in disease pathology, but policy issues.

Hughes said lower-cost practitioner care is another problematic claim.

Studies, Hughes said, have demonstrated that nurse practitioners order more tests and are more likely to refer patients to expensive specialists compared with primary care physicians, who can handle subtle, difficult medical issues themselves.

Physicians, Hughes added, are facing pay issues because some insurers are paying nurse practitioners on par with doctors.

Dr. Atul Grover, chief public policy officer of the Association of American Medical Colleges, said efforts are under way to increase the number of physicians in primary care.

This year, Grover said, there were 1,438 new openings for residencies in primary care.

Grover said shoring up the doctor shortage is possible, but it may take years.

Martin insists that nurse practioners are ready now.

"We have four schools of nursing here on Long Island that are churning out nurse practitioners and enrollment is not declining -- it's going up," she said.

"Nurse practitioners are ready and waiting in the wings. We just need the handcuffs removed," Martin said.

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