Filling the gap: Nurse practitioners caring for more patients

The American population is getting older and sicker, and there simply aren't enough primary care physicians to go around. According to the American Academy of Family Physicians, the United States will see a shortage of 40,000 family physicians by the year 2020. To handle the demand for primary care health services, the need for -- and responsibility of -- nurse practitioners is on the rise, especially in rural and underserved areas.

"It's very typical of nurse practitioners that we tend to go places physicians don't want to go. We're filling a real need here," says Paul Mackey Jr., Ph.D., a family nurse practitioner at Comprehensive Family Healthcare in Benton, Mo. The rural health clinic, owned by collaborating physician Dr. Michael Jessup of Cape Girardeau, is the only medical practice in Benton, set 20 miles from Cape Girardeau and Sikeston, Mo., in either direction. The clinic accepts Medicaid and Medicare, says Mackey, and patients travel from Oran, Chaffee, Scott City, New Madrid, and even Cape Girardeau and Sikeston.

"The severeness of our patients has definitely gone way up. A lot of people are very, very ill," says Mackey. In addition to handling basics like sprained ankles, school physicals and the seasonal flu, the clinic is the primary care provider for many patients, some of whom are battling chronic diseases that require a great deal of medication and interaction with a health professional.

Mackey sees little difference between a nurse practitioner and doctor, and adds that when it comes to treating patients, he can do 85 to 90 percent of what a physician can do. For Kim Keser, a family nurse practitioner at AWL Family Health Care Center in Cape Girardeau, the only difference is in how -- not what -- nurses and doctors are taught. According to Keser, doctors' education focuses on medicine, treatment, diseases and diagnoses, while nurses are taught a more humanistic and wholistic approach to caring for patients.

"We probably spend more time educating patients, explaining how to take medications and why, and what's going on," says Dolores McDowell, a family nurse practitioner and founding partner of AWL. "We're all about teaching the public how to take care of themselves and be proactive when it comes to preventing and managing diseases, especially chronic diseases like obesity, diabetes and hypertension."

But the real glaring difference between nurse practitioners and doctors is in state regulations for nurse practitioners, and Missouri is noticeably "behind the times," says Mackey. Missouri is one of only a few states requiring nurse practitioners to work with a collaborating physician no more than 50 miles away, and although legislation granted nurse practitioners the right to prescribe controlled substances two years ago, the details have not been determined.

"I can diagnose an abscessed tooth, but I can't prescribe pain medication," says Mackey. "We'll eventually be able to do it, but how we can do it and what drugs we can prescribe is yet to be seen. It could be up to two more years."

Says Keser, "Health care is for the patient and it should be driven by the patient, but so many times it's not about the patient."

Sandy Buchheit, a nurse practitioner at MedStop One in Cape Girardeau, has been a nurse for 35 years, with the last 15 as a family nurse practitioner. In that time, she has seen the role of nurses change greatly, and she expects nurses to be in higher demand, with bigger responsibilities, in the future.

"When I started 30-something years ago, the opportunities available were to work in hospitals or clinics or to teach. There were not a lot of nurse practitioners," says Buchheit. "Nurses have become much more independent in their practice, and I see that as becoming more and more increased because of the need for more entry-level health care providers for the growing indigent population." That population includes baby boomers as well as the very poor who cannot afford health care. "Rural health clinics were developed to help fill that need," says Buchheit.

Marie Wright, another nurse practitioner at AWL, believes nurse practitioners will be crucial in caring for the poor and elderly as well as today's young people. Wright notes that the life expectancy for her age group is 80 to 85, but because of the childhood obesity epidemic, today's teens and preteens have a life expectancy of only 60 to 65. Since obesity is tied to so many other diseases, those patients will require more intensive primary care and at an earlier age.

So what will it take for America to be able to accommodate those patients?

"The way we provide medical services has to be united," says McDowell, rather than separated into doctors and nurses, hospitals and clinics. "We shouldn't be segmented. We should be a closer team."

Mackey believes it will take a crisis before significant action is taken. "That's about the only thing that makes people want to change," he says.