Nurse Practioner Need in Alaska, Essay Example

Evidence of the Need for Family Nurse Practitioners and the General Practitioner Shortage

Mr. Porter:

There is a 30 percent shortage of general practitioners in the State of Alaska. Out of 17 Alaskan areas, 15 of these areas demonstrated a 20 to 40 percent need for general practitioners.  Many of the problems contributing to the shortage were not medical in origin, such as: transportation, financial barriers, access to care, and remote locations.  (Johnson, & Norris, 1997).

According to a study by Rabinowitz, Diamond, Veloski and Gayle, (2000), there are four predictors that must be met by general practitioners before those physicians may adequately provide medical coverage to Alaskan citizens. These physicians must be a part of the same ethnic minority served, have participated in National Health Service Corps, and the physician/medical student was raised in the same area where care is lacking. Unfortunately, few of the physicians growing up in an Alaskan underserved area meet these criteria, with only 834 of the 504,076 Alaskan physicians being natives of Alaska, with 14 percent of these physicians are female. (Anonymous, 2000).

Alaska has the lowest number of medical school slots in the country, and has one three-year program, which graduates 12 family practitioners per year.  There a seven-year time span required for these physicians to graduate. In contrast to Alaskan physician graduation rates, Texas has 6,400 openings in their medical schools, and California has 9000 residents allotted per year. (Sherwood, et al., 2010). Medical students must spend much of their time in residency outside of Alaska if they are training in a specialty.  To make the situation even worse, students must take on expensive loans, are attending residencies outside of Alaska, only to train in a specialty that is more lucrative, and then ultimately these students do not necessarily return to Alaska to practice upon graduation. The lure of better pay and greater demand elsewhere drains the graduating class of physicians, leaving Alaska without a sufficient number of practicing physicians, and in particular, general practitioners. (Sherwood, et al., 2010). 30 percent of medical students are interested in primary care once graduated, whereas 48 percent demonstrate an interest in higher paid prestigious positions. Medicare reimbursement in the general practitioner field is less than half of the normal earnings these physicians would like to make.

Cost effective and preventative

By preventing long term illnesses, the FNP can cut the cost of traditional treatment for illness-only approaches. Increasingly it is known that “Physicians, hospitals, clinics, HMOs and public health care systems will view their use as a means of containing escalating health care costs, “To the patient this will mean an increase in the availability of comprehensive healthcare services and the prevention and early detection of medical problems through wellness care”(Williams and Williams, 1990). FNPs can improve cost effectiveness by providing care to acute and chronically ill individuals in doctor’s offices, clinics, emergency departments, and hospitals. The specialty of the FNP is tertiary and preventative (College of Nursing, Roles of Advanced Practice Nursing, 2008).  In addition, nurse FNPS can improve cost effectiveness by making treatment more accessible, especially for poor isolated individuals suffering as a result of the current shortage of general practitioners (Perloff, Kletke and Fossett, 1995). Furthermore, “The increases in payment level needed to increase the proportion physicians participating fully would be substantial, however, and may not be politically feasible”  (Perloff, et.al., 1995).

Advantage of Preventative Care as One of the Main Goals of FNP

In an article by Marmor, Oberlander, and White (2009), the Obama administration is concentrating on cost savings through prevention, changing the reimbursement and payment system, and disease management. FNPs would provide support to these proposals, and playing the role of a preventative holistic nurse and clinician would provide cost savings overall in providing care to chronically ill patients, who otherwise would only obtain treatment for acute illnesses. FNPs also fill the gap in declining medical school graduates, and may fulfill valuable medical needs of the community that physicians cannot currently accommodate. Cost reduction is observed from the management of routine diagnostics and preventative care and education to lesser paid FNPs, rather than excessively trained physicians (Mahar, 2010). According to Sherwood, Brown, Vaunette, and Wardell (2010), the following observations are made regarding the role of FNPs in these areas:

• FNPs can reduce costs by performing many of a physician’s redundant tasks, which will free the doctor up to complete other responsibilities
• The community can save money by providing services for isolated residents through small satellite clinics run by FNPs, under the direct supervision of general practitioners

FNPs could also work to stop the deterioration of these medical services by providing preventative palliative and acute/chronic care to areas as diverse as dialysis centers, long-term facilities, as well as industrial and public health agencies.

Policy Recommendations

Initially, there should be (1) the implementation of a state wide program that pays physicians for participating in a mentoring program and for FNP practice oversight; (2) provide bonuses, moving expenses, encourage FNPs to move to other areas, and also improve upon existing wage structures and working environments compared to those seen in other parts of the country; (3) develop an ongoing advertising campaign in nursing magazines to promote these recommendations; (4) lastly, impose a 1 percent income tax on individuals or corporations that earn over one million per year, for the purpose of establishing a separate agency to address the issues lacking in the present healthcare system. The estimated time required from the start of the program until it is fully funded and operational is 18 months. By not taking immediate action, Alaskan residents will begin to move out of the state and a reduction in the tax base will be imminent. The state will not possess a sufficient number of physicians to keep the sick healthy, and will not possess the tax revenue that is necessary to provide alternatives and creative solutions other than the use of FNPS.

References

College of Nursing, Roles of Advanced Practice Nursing, (2008).  Roles of Practice Nurses.  Retrieved from: http://.mc.uky.edu/Nursing/academic/msn/trackdesc.htm

Compton, M., Frank, E.,  Elon, L., and  Carrera, J. (2008). Changes in U.S. Medical Students’ Specialty Interests over the Course of Medical School. Journal of General Internal Medicine. 23(7): 1095-1100. From             http://www.ncbi.n.m.nih.gov/pubmed/18612751

Johnson, R, R., and Norris, R.E. (1997). Geographic distribution, supply, and need for generalist physicians in Alaska. Western Journal of Medicine 167(5):330-335. PMCID: PMC1304619

Mahar, M. (2010). The battle over Letting Nurse Practitioners Provide Primary Care. Retrieved from: http://Takingnote.tcf.org/2010/04/the-battle-over-letting-nurse-practitioners-provide-primary-care-.html

Marmor, T., Oberlander, J., and White, J. (2009). The Obama Administration’s Options for Care Cost Control: Hope Versus Reality. Annals of Internal Medicine, 150(7): http://www.annals.org.login.hmlproxy.lib.csufresno.edu/content/150/7/485.full

Perloff, J., Kletke, P., and Fossett, J.W. (1995).  Which physicians limit their Medicaid participation, and why.  Pub MED Central.  From http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1070348/

Rabinowitz, H., Diamond, J., Veloski, and Gayle, J. (2000). The impact of multiple predictors on generalist physicians’ care of underserved populations. American Journal of Public Health, 90(8): 1225-1228.

Sherwood, G., Brown, M., Vaunette, F, and Wardell, D. (2010).  Defining Nurse Practitioner Scope of Practice: Expanding Primary Care Services. The Internet Journal of Advanced Nursing Practice.  Retrieved From: http://www.ispub.com.hmlproxy.lib.csufresno.edu