QUESTION:
Does anyone know the percentage of NPs that practice in rural communities?
I am at the Rural Advisory Committee for HRSA and this came up as part of ACA. Specifically, a demonstration training program for NPs as a way of funneling more into rural medicine. My experience is that most practice in urban or suburban settings. My concern is that this would detract from training FPs for rural settings. How could we measure whether this was a cost effective and appropriate use of resources.
Sorry, I am limited on time.
REPLY (WMR):
At Vanderbilt, Dean Conway Welch presided for years saying that her nurse practitioner programs made it unnecessary for Vanderbilt to have a family medicine program. Some years ago she noted that few of her NP's were in primary care, and even fewer were staffing rural sites. Some exceptions.
In fact, nurse practitioners were attaching themselves to the legions of cardiologists and other surgical subspecialists for which Vanderbilt is so well known. In a brilliant about face, she relabeled her brochures with the following title more or less " Nurses Practitioners--Come to Vanderbilt and Subspecialize".
No one has dared to publish the numerators and denominators suggesting that the empress has no clothes on the original promise of care like that of the family doctor. Sadly, some of data has been gerrymandered or manipulated.
... If you can stand to hear the words you've spoken
twisted by knaves to make a trap for fools.....
In Tennessee, medical schools still count every internist, pediatrician, and OB as "primary care" even though most subspecialize. Nurse practitioners have not solved the health care maldistribution problem in Tennessee. But, urban FQHC's are hiring them as rapidly as they can find them. The tree of family medicine has been lost in this forest of generic primary care.
When Tennessee has rural interest day in Nashville, the halls of the legislature are filled with banner after banner describing how Vanderbilt has provided health care for each and every rural county. This is a genuine service and I give them credit for the patients they have helped. Basically the Vanderbilt banners describe people who transferred or voluntarily traveled to Vanderbilt for specialty services. They attach the "nonreimbursed dollars" for each county.
Vanderbilt has the ingenuity and resources to gather descriptive statistics and craft them into a skillful public relations campaign. The advertising implication is that Vanderbilt is on the rural scene providing services throughout the state, and that significant amounts are not reimbursed. It is an amazing feat of political finesse.
Family Medicine has struggled to find the high ground for legislative attention of this magnitude. It would be nice if schools like Vanderbilt could be convinced to provide leadership in establishing family medicine as the logical captain of a multidisciplinary team providing healthcare services unrestricted by age, gender, pregnancy and location of service, but.....
With best wishes for your professional success,
Wm. MacMillan Rodney MD, FAAFP, FACEP
Clinical Professor and Chair
Medicos para la Familia
Procedural Skills and Office Technology
www.psot.com
www.medicosmundial.com
Index--Nurse practitioner data
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