If you look hard enough, you can often find a survey or poll to support your stance on an issue, whatever it may be. But in some cases, you don't need to look hard at all. A range of "majority opinions" flows freely.
Such is the case with opinions on advanced practice registered nurses, including nurse practitioners, and how involved they should be in care delivery. The turf war between physicians and mid-level providers isn't exactly unexpected, given the professional prestige at stake for each. Many physicians and nurse practitioners have substantially different perceptions about their roles.
For instance, about two-thirds of physicians said if a physician and NP provided the same service, physicians would do it better, according to a May 2013 survey from the New England Journal of Medicine. Seventy-five percent of nurse practitioners disagreed with that statement. That same survey found 82 percent of nurse practitioners felt NPs should lead medical homes, whereas only 17 percent of doctors felt the same.
Those are some considerable gaps in opinion, but then again, those respondents are on different sides of a lengthy argument in the medical community. It'd be news if physicians and NPs didn't disagree on this issue.
What is more surprising is the clash of consumer or patient surveys, even in the past six months alone. Below are two recent survey results we've covered at Becker's Hospital Review:
Survey: Consumers Open to Larger Physician Assistant, Nurse Practitioner Roles (June 2013)
The Association of American Medical Colleges' Consumer Survey recently found patients welcome PAs and NPs to play a larger role in their care, according to an article in Health Affairs. When survey respondents were asked which provider — a physician, physician assistant or nurse practitioner — they would prefer to see, 50.3 percent opted for a physician, according to the article. However, when respondents were presented with a scenario of seeing a PA or NP today as opposed to a physician tomorrow for a worsening cough, 59.6 percent chose to be seen by a PA or NP.
* Survey data was based on responses from 2,053 adults who indicated that they or a physician believed they needed medical care at least once in the past year, according to the article.
Poll: Americans Prefer to See Physicians (December 2013)
A majority — 72 percent — of Americans prefer to see a physician over a nonphysician provider for their medical care, according to a survey conducted by Iposos, a private research think tank. Additionally, 90 percent would choose a physician to lead their "ideal medical team," while only 1 in 10 respondents would choose a nurse, nurse practitioner, physician assistant or chiropractor to do the same.
* Results are based on a survey of 1,000 adults and 363 opinion leaders (people registered to vote, have at least a college degree, are over 25, are employed or looking for work, make more than $50,000 annually, are heavy news consumers and are politically engaged) conducted between Nov. 8 and Nov. 15.
It's unlikely the consensus changed that dramatically in six months. The biggest takeaway from these surveys is that we are in need of more scientific studies and national data — not surveys or polls — on differences in care delivery that is physician- or advanced practitioner-led.
NPs weren't born yesterday: The role emerged in the 1960s during another time of projected physician shortage. Today, the country's primary care physician shortage is very real, paired with growing demand for services from the healthcare reform law's newly insured and an aging baby boomer population.
There have been small but steady steps toward expanded roles for APRNs recently. You may notice many TV commercials use the term "Please talk to your healthcare provider" now in lieu of the traditional "Please talk to your doctor" line. Last week, the Federal Trade Commission said the elimination of certain supervision requirements for NPs and nurse anesthetists would likely benefit competition in Massachusetts — a perspective that makes for an important business-minded argument.
And the country's largest healthcare system with more than 1,700 hospitals in all 50 states — the Veterans Health Administration — is in midst of a dispute about a proposal to let APRNs practice without physician supervision, even in states that have laws requiring oversight. (The opposition and support for that proposal is nearly even to a tee: More than 60 states and national physician groups have signed a letter with their "strong concerns" to the Department of Veterans Affairs, whereas about 40 nursing organizations have endorsed letters applauding the proposed changes.)
It seems inevitable that physician extenders will be more involved in care, especially in light of our country's subpar access to primary care providers. The U.S. came in dead-last out of the 11 countries in a November 2013 Commonwealth Fund study for after-hours primary care. Only 35 percent of adults' primary care physician practices have arrangements for patients to see physicians or nurses after hours. (In the Netherlands and the United Kingdom, this figure is 95 percent.)
Those are just a few recent happenings and forces that suggest APRNs' roles in care delivery may expand more quickly than opinions on the matter can dictate. In light of this, patients and providers need reliable information on consumer opinions rather than conflicting, blanket poll numbers. This can no longer be treated as a game of nationwide he-says/she-says.
But even if such opinion polls continue to persist (and I expect they will), it would be helpful if more questions or results were categorized, such as by age group or acuity of care. How do younger patients feel about APRN-led care delivery versus a those who are 65 years or older? How does someone with several chronic diseases feel about it compared to a patient who visits her provider for an annual physical exam?
Some studies have taken these steps, but more results like this could break down blanket "majority opinions" to better understand which patients are most uncomfortable receiving care from professionals other than their physicians. Findings like this could leave healthcare providers in a better position to address those concerns — to "put the patient first" as so many hospitals and health systems claim to do.
And for the patients out there: Think twice before letting these surveys shape your opinion — whatever it is — on who delivers your care. In a few months, another poll may show completely different results.