In Support of Primary Care Medicine

January 2015
David Vlahov

Recently, an article in Academic Medicine described the results of a survey that found 66 percent of primary care physicians (PCPs) would recommend becoming a primary care nurse practitioner (PCNP) as a career choice, whereas only 56 percent of PCPs would recommend a career in their own profession. Conversely, 88 percent of primary care nurse practitioners would recommend their own career.

As one of many nurses who have argued long and loud that the challenges of health care reform demand that we expand the scope of practice for nurse practitioners, I might be expected to take some pleasure in such findings.

I do not; I find the survey results dispiriting. A shrinking pool of primary care physicians is unequivocal bad news for anyone who cares about creating a truly responsive and high-quality system of care.

Consider one key passage of the article:

It is possible that Primary Care Physicians’ greater willingness to recommend a career as a PCNP over a career in their own profession could reflect their pessimism about the future of primary care medicine. Dissatisfaction with factors not assessed in this survey – lower payments and incomes relative to specialists, long work hours, increasing bureaucracy and compliance oversight, devaluation of primary care among the academic medical community, the additional years of education, and high debt levels following the completion of medical education, particularly in relation to their salary as compared with physicians in other specialties – could weigh heavily enough to offset PCPs’ misgivings about PCNPs and thus explain their greater willingness to recommend that qualified students pursue careers as PCNPs.

If the authors’ speculations about the sources of primary care dissatisfaction are correct – and such thoughts are nothing new for those of us who count primary care physicians as friends and colleagues – then it is time for all of us to find ways to turn this train around. A strong primary care physician workforce is a non-negotiable necessity for quality care.

Therefore, we must build new incentives for primary care medicine into the evolving designs for health care delivery and academic medicine. We must work together with our primary care physician colleagues to create and sustain the conditions necessary to maintain and expand their vital practice. Even as PCNPs have sought a wider scope for their own practice, it has always been in the context of adding value to an essential partnership with primary care physicians and other health professionals to enhance health and well-being for all individuals.

To be clear: becoming a PCNP is a great career choice. Yet PCNPs do not exist to replace primary care physicians. We are not interchangeable. There may be overlap in our roles, but there is also important differentiation where each provides additive value to health care delivery and the health of our patients.

If nursing is dedicated to creating and being part of a comprehensive health system that meets the needs of disease prevention, management and health promotion, then we must advocate for a strong primary care physician workforce that feels truly energized about bringing its expertise and innovation to our shared mission.

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