Issue Brief: Educational and Training Comparison

Compare the Education Gaps Between Primary Care Physicians and Nurse Practitioners

While nurse practitioners are trained to emphasize health promotion, patient education, and disease prevention, they lack the broader and deeper expertise needed to recognize cases in which multiple symptoms suggest more serious conditions. The primary care physician is trained to provide complex differential diagnosis, develop a treatment plan that addresses multiple organ systems, and order and interpret tests within the context of the patient’s overall health condition.

This expertise is earned through the deep, rigorous study of medical science in the classroom and the thousands of hours of clinical study in the exam room that medical students and residents must complete before being allowed to practice medicine independently.

Because primary care physicians throughout the United States follow the same highly structured educational path, complete the same coursework, and pass the same licensure examination, you know what you’re getting with a physician. There is no such standard to achieve nurse practitioner certification, as their educational requirements vary from program to program and from state to state.

Nurse practitioners can achieve certification by completing an associate’s degree program or nursing diploma program, and go directly into a master’s degree program—some of which can be completed online—or they can complete their Bachelor of Science degree in nursing. At the point of certification, a new nurse practitioner has acquired between 500 and 1,500 hours of clinical training, fewer than a third-year medical student. A new family physician has acquired more than 15,000 hours of clinical training.

• A 2004 survey of practicing nurse practitioners published in the Journal of the American Academy of Nurse Practitioners reported that in the area of pharmacology, 46% reported they were not “generally or well prepared.”¹

• From the study: “In no uncertain terms, respondents indicated that they desired and needed more out of their clinical education, in terms of content, clinical experience, and competency testing.”¹

• Also from the study: “Our results indicate that formal NP education is not preparing new NPs to feel ready for practice and suggests several areas where NP educational programs need to be strengthened.”¹

The complex chemistry and powerful therapeutics of modern pharmaceuticals require substantial expertise to carefully titrate dosages and account for the very real risks of toxicity, therapeutic failure, chemical dependency, adverse side effects from drug interactions, and simply wasting scarce health care resources through over- or under-prescribing. Pharmacology and pharmacotherapy are closely integrated into every aspect of medical train­ing, providing an educational foundation that far exceeds the nominal exposure nurse practitioner programs offer.

• A study on antibiotic prescribing published in the American Journal of Medicine in 2005 found that non-physician clinicians were more likely to prescribe antibiotics than were practicing physicians (26.3% and 16.2%, respectively) in outpatient settings.²

• Another study suggested that many nurse practitioners had not received enough education in microbiology, knowledge integral to effective treatment for bacterial, fungal, as well as viral disease.³

• A six-year study published in 2006 found that rural nurse practitioners were writing more prescriptions than their urban nurse practitioner counterparts, physicians, and physician assistants.⁴

1. Hart A and Macnee C. “How well are nurse practitioners prepared for practice: results of a 2004 questionnaire study.” Journal of the American Academy of Nurse Practitioners. 2007, Vol. 19, No. 1, p. 37.

2. Roumie C and Halasa N. “Differences in antibiotic prescribing among residents, physicians and non-physician clinicians.” American Journal of Medicine. June 2005, Vol. 118, No. 6, pp. 641-648.

3. Sym D et al. “Characteristics of nurse practitioner curricula in the United States related to antimicrobial prescribing and resistance.” Journal of the American Academy of Nurse Practitioners. September 2007, Vol. 19, No. 9, pp. 477-485.

4. Cipher D and Hooker R. “Prescribing trends by nurse practitioners and physician assistants in the United States.” Journal of the Amercian Academy of Nurce Practitioners. June 2006, Vol. 18, No. 6, p.6.

Atlantic Health Partners offers Kentucky Academy of Family Physicians the overall best purchasing terms for Sanofi’s Fluzone, Merck’s Afluria, and MedImmune’s Flumist.  As the leading vaccine buying group in the country, Atlantic can assist your practice with reserving flu doses for the upcoming flu season, including Sanofi’s High-Dose and Intradermal Fluzone.

Furthermore, Atlantic Health Partners provides our members with the lowest costs for the complete spectrum of Sanofi and Merck vaccines.  Thousands of physicians nationwide have seen how Atlantic can improve the financial and operational practice performance of providing immunizations to your patients.

In addition Atlantic Health Partners offers a unique program that enables physicians to provide vaccines like Zostavax to Medicare Part D patients with fair and timely reimbursement.

We encourage you to contact Atlantic Health Partners to determine how their program can be of benefit to your practice.  You can reach Jeff or Cindy at 1-800-741-2044 (Eastern Time) or at info@atlantichealthpartners.com

• Kentucky State Police states that up to 77% of PSE sales are being diverted to make meth.
• Oregon became the first state in 2005 to make PSE a schedule III drug. They have gone from a high of 525 in 2002 to 10 meth labs in 2010.
• Mississippi became the second state to make PSE a schedule III, and they have seen a 68% reduction in meth labs.
• Kentucky had 111 children contaminated at meth labs during 2009.
• During 2009, Kentucky experienced the death of 22-month old toddler, Kayden Branham, after drinking drain cleaner being used at a meth lab.
• PSE by Rx is the only proven method to eliminate Smurfing (person(s) buying PSE for resale to a meth cooker)

Call toll-free legislative message line at (800) 372-7181, and leave a message for all legislators.

Call your individual state representatives and senators at (502)564-8100.  Give the LRC operator the name of any representative or senator in Kentucky, and they wil transfer you to the appropriate office.  Let them know how you feel about this issue.

Send an e-mail to individual legislators letting them know that you support PSE by Rx.  The e-mail address of every Kentucky representative and senator can be found at the following website: http://www.lrc.ky.gov/whoswho/email.htm.

Write a “Letter to the Editor” of your local or school newspaper to voice your support for SB50.

More bullet points at http://realfactsaboutmeth.com/Home.html

https://www2.gotomeeting.com/register/455094482

To  learn more and see example letters of support go to http://www.Nkyletterssmokefreekentucky.com

BTE is a national pay for performance program of the Health Care Incentives Improvement Institute (HCI3), a not for profit organization. To earn Recognition, clinicians must meet benchmarks on measures such as:

• Blood pressure
• LDL levels
• HgBA1c levels
• Ophthalmologic and podiatry exams
• Nephropathy assessment

Those who do will improve overall patient health and well being, while reducing the risk of potentially avoidable complications.

To learn more about Bridges to Excellence, please visit www.bridgestoexcellence.org.

Medscape recently referenced an article from the JABFM that brings up the concern that many rural family physicians, who may use procedural CPT and/or non-office E&M codes as a greater proportion of their total billing than their urban counterparts, may not reap the benefits of the Patient Protection Affordable Care Act that defines primary care as a specific set of E&M codes.  A new calculation under consideration by CMS would raise the percentage of Family Physicians eligible for the bonus from 53% of Family Physicians up to 80%.

 J Am Board Fam Med. 2011;24(6):637-638. © 2011 American Board of Family Medicine

To read medscape article go to  http://www.medscape.com/viewarticle/753801?sssdmh=dm1.757231&src=journalnl

Health care officials from throughout Kentucky described massive problems Wednesday with the state’s new Medicaid managed- care system — resulting in …

http://www.courier-journal.com/article/20120208/NEWS01/302080099/Officials-Care-disrupted%3Fodyssey%3Dtab%257Ctopnews%257Ctext%257CHome&ct=ga&cad=CAEQARgAIAAoATAAOABAkPrM-QRIAlgBYgJlbg&cd=yuZR4dxhJjA&usg=AFQjCNEGVSay3TmTf2EXEoDbeg09iuOX5A

Notice is hereby given of the 61^st Annual Scientific Assembly Session of the Kentucky Academy of Family Physicians to be held at the Crowne Plaza Campbell House, April 27-28, 2012. Pursuant to Article VII Bylaws of the Kentucky Chapter, American Academy of Family Physicians, the 52^nd Annual Meeting of the Congress of Delegates will be held Saturday, April 28, 2012 at 8:00am to receive and act upon reports of officers and committees, to elect officers and to transact any and all business that may be placed before Congress. All Officers, AAFP Delegates/Alternate Delegates, Regional/District Directors are requested to register in advance. Registrations will be mailed out in March and can be accessed from the KAFP web site www.kafp.org. If you should have any questions please contact Janice Hechesky at 1-888-287-9339.