Doctors to Lawmakers: Remember, People Like Us

Physicians look to leverage their popularity amid contentious debate over nurses.

Dr. Martha Perez examines Maria Lebron in a room at the Community Health of South Florida, Doris Ison Health Center on February 21, 2013 in Miami, Florida. (National Journal)

Family physicians have a message as Congress and state legislatures consider a range of policies that would squeeze doctors' pay: People still want their doctor in charge.

There's a shortage of primary-care doctors in the U.S., and demand is about to surge because of the coverage expansion in the Affordable Care Act. As a result, many states are considering measures that would let nurses and nurse practitioners take on more responsibility.

But the American Academy of Family Physicians says that's not the answer--and that patients won't like it, either. According to a new survey that AAFP commissioned, 72 percent of Americans say they want to see a doctor for their medical care, compared with just 7 percent who say they want to see a nurse practitioner.

AAFP's survey says people rate nurse practitioners highly on attributes like being "comforting" and "a good listener," but rate doctors higher on "who I want to see when I am sick."

AAFP President Reid Blackwelder said it's "very encouraging to have affirmation" of what primary-care doctors already believed--that they're the ones people turn to and want to continue to turn to.

Nurse practitioners released their own competing poll last month, in which 62 percent of respondents said nurse practitioners should be able to provide certain services--such as writing prescriptions and ordering diagnostic tests--without supervision from a physician.

The battle between nurse practitioners and physicians is playing out ahead of a surge in demand for health care, with as many as 30 million people expected to come into the system through Obamacare. Primary care isn't an especially lucrative specialty in the first place, and Blackwelder said residency opportunities for primary care will be in short supply in just a few years.

"The workforce issue is huge," he said.

Instead of boosting nurse practitioners' role, AAFP wants lawmakers to address the doctor shortage by funding more residency programs in primary care and increasing doctors' payments under Medicare and Medicaid.

But those priorities are all waiting in line behind a permanent "doc fix," Blackwelder said. He said Medicare's payment formula for physicians is the single biggest threat to primary-care doctors. AAFP supported this year's bipartisan, bicameral push to permanently replace the formula, which calls for payment cuts that Congress routinely delays. That effort didn't make it across the finish line this year because lawmakers couldn't agree on a way to pay for a permanent fix.