The aches and pains of the health industry

Our nation is experiencing an upheaval with the health care system. One of the issues is the decline in the number of physicians opting for careers in family practice. Another is a growing trend of primary care doctors turning away Medicare patients. Medicare is the federal insurance program for Americans 65 and older.

A 2006 Report of the Alaska Physician Supply Task Force by the Alaska Department of Health and Social Services and the University of Alaska states that lack of primary care services in the state is an issue of escalating importance.  It is estimated there is a current shortage of 375 physicians in Alaska. By 2025 another 1100 physicians -- in addition to the 1,347 in practice in 2006 -- will be needed to make up the existing deficit, to replace doctors who retire or move away, and to provide the additional care for Alaska's growing elderly population. The task force also recommends that Alaska maintain the current high ratio of mid-level providers to physicians, including Nurse Practitioners (NPs), a ratio that is currently higher than the national average "in order to provide high quality and timely care to the population. Without these providers the need for physicians would be even greater."

Fortunately, NPs are stepping up to the plate in increasing numbers to provide those needed services in a high quality and cost-effective manner. NPs are held to the same standards as doctors concerning ethical and medical responsibilities and numerous studies over the years have shown that NPs and doctors have the equivalent medical outcomes with patients.

Barbara Berner, associate professor of nursing at UAA and a family nurse practitioner in Anchorage, conducted a 2009 survey through the Alaska Nurse Practitioner Association and discovered that approximately 500 NPs live and work in the state of Alaska. Recent survey data indicate that 73 percent of them accept Medicare reimbursement for services. Approximately 38 percent practice in rural and underserved areas. Approximately 24 percent of family nurse practitioners (FNPs) who function as primary care providers in Alaska are graduates of the UAA FNP Program. These data translate to over 200,000 primary care visits per year in Alaska provided by UAA FNP alumni.

Some individuals may prefer to see an NP due to their different philosophical perspective. Traditionally, doctors have been trained in the 'medical model' which focuses on treating the disease whereas NPs are trained in the 'holistic model' which focuses on treating the whole person, including the psychological and social mechanisms along with the physical and includes a strong emphasis on prevention.

Nursing is one of the last health care professions to develop a practice doctorate. The American Association of Colleges of Nursing voted in 2006 to recommend that by 2015, the educational entry level for all Advanced Practice Nurses will be a doctor of nursing (DNP) degree. UAA's School of Nursing, which is committed to serving the health care needs of the citizens of Alaska, particularly underserved populations such as the growing Medicare population, has a proposal in the works for an advanced nursing practice doctoral program that will replace the currently existing master's level NP programs.

Berner says, "Changes both within the nursing profession and the evolving health care needs on our population have led to these developments, not specifically as a response to the Medicare issues."

If fully implemented, the Doctor of Nursing Practice curriculum at UAA will prepare NPs with the highest level professional knowledge and skills necessary to assure high quality care that will serve the needs of the citizens of Alaska in today's rapidly changing health care environment.