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Doc Shortage, Obamacare Shift Burden to Nurses

An NBC News series called “Quest for Care” has been exploring the front lines of health care, with an eye toward the expected impact of the Affordable Care Act, or Obamacare. The upshot:  a shortage of primary care physicians has increased the burden on nurse practitioners – though “scope of practice” laws in many states limit NPs’ ability to meet the demand.

A recent article in the series focused on Mary Fey, a family nurse practitioner in the rural community of Dexter, OR. Fey is the sole primary care provider for 30 miles around, and Obamacare is expected to increase her burden.

“I’m pushing 1,500 patients now and that’s going to increase,” said Fey. Thirty-two million Americans are expected to gain new access to health insurance under Obamacare.

Fey expects her practice to jump as much as 40 percent beginning in January. Instead of getting an appointment the next day, her patients may have to wait a week, she says.

That’s a scenario that will likely play out across the country, said Dr. Atul Grover, chief public policy officer for the Association of American Medical Colleges (AAMC), which is tracking the doctor shortage.

The AAMC estimates the U.S. is already short more than 9,000 primary care physicians, a number it expects to rise to 65,800 by 2025.

“To me, nurse practitioners could be a huge, huge solution to this problem of primary care shortage,” said Dr. Thomas Bodenheimer, a professor of family and community medicine at the University of California, San Francisco, School of Medicine. A trend toward nurse-based care can be seen in the number of Medicare patients treated by NPs, which increased 15-fold from 1998 to 2010.

In 18 states, including Oregon, NPs like Fey can practice independently, without the supervision of a physician. But “scope of practice” laws in other state hamstring the degree to which nurses can practice independently – even though repeated studies comparing the primary care provided by both NPs and MDs have shown  that patients of NPs do as well or better in terms of health outcomes and satisfaction.

Fey figures there are about 8,000 people in her coverage area, including many with common chronic ailments: diabetes, obesity, heart disease. She anticipates that expanded access to insurance will spawn a flood of new patients who haven’t had health care in years.

“They have 12 things wrong and they save it up,” she said. “Then they say, ‘Why can’t you fix me, Mary?’”