Nope, it’s not your imagination. It really is taking longer and longer to get an appointment with a doctor. Wait times in major metropolitan areas increased by 30% between 2014 and 2017, according to one survey, and they’re even longer in smaller cities. To make matters worse, once you’re actually in the doctor’s office, you’ve typically got only about 20 minutes to get all your concerns addressed.
This isn’t a commentary on physicians—we love our MDs and DOs! But it is a reflection of the physician shortage affecting our country. In fact, we’re estimated to hit a deficit of more than 121,000 physicians by 2030. The shortage of docs is already creating huge barriers to healthcare access, especially in rural areas, where only 11% of physicians choose to practice. Take Kentucky, for instance, where 102 of the 120 counties have been designated as “medically underserved areas.”
While many may feel we should hold tight and wait for a new generation of students to become physicians, we simply don’t have that time. There is another group of safe and quality providers who are primed to help fill the healthcare gap right now: Advanced practice registered nurses (APRNs). These graduate-educated APRNs can provide many of the same services as physicians because they have rigorous training above and beyond that of a registered nurse, including at least a master’s degree in nursing (about 18% have a doctoral) plus hundreds or even thousands of hours of hands-on specialized practice. What’s more, their patient outcomes are comparable to physicians’ research shows. But there are two key obstacles to this solution.
Why can’t we all access the care we deserve?
The first challenge is that an APRN’s freedom to practice their profession varies from state to state. In half the country (24 states plus Washington, D.C.), APRNs have what’s called full practice authority (FPA), meaning they can practice to the full extent of their education and training without unnecessary restrictions . But in the remaining states, APRNs must enter a contract with a physician, who can limit the APRN’s scope of practice and tie their ability to provide care to a physician. For instance, in some states an APRN with specialty training in pediatrics can’t treat children if her collaborating physician only works with adults. Fortunately, that may soon change as many state legislatures push to adopt full practice authority, including Florida, Kansas, Kentucky, and Mississippi, which have bills pending in their State Legislatures. (To learn how to support APRNs in your state, click here.)
So what does an APRN do, exactly?
The other problem is that most of us don’t know what an APRN is, much less what they can do. “Many patients don’t understand that we can be their primary care provider and determine if in fact, they need a specialist,” says Wanda Stroupe, DNP, FNP-BC, a family nurse practitioner and chairman of the Clinic Owners Committee for the Mississippi Association of Nurse Practitioners.
So, when can you forgo a weeks-long wait for that doctor’s appointment and instead go straight to an APRN for the same care? If you live in a state with full-practice authority, here are just a few of the scenarios when you’ll want to visit an APRN.
1. When you’re seeking a diagnosis
Consider a family nurse practitioner (FNP) like Stroupe your first line of defense against any as-yet-unnamed malady. “We're trained in the whole scope of care, starting with newborns all the way through the very elderly, so we can diagnose you at any age,” says Stroupe. “And we do it by following the same best-practice guidelines that any medical doctor would follow.”
APRNs can also order any diagnostic tests needed to help determine that diagnosis. “MRIs, CT scans, X-rays, all the points-of-care tests like strep, flu, a complete blood count—we can order any test that’s appropriate for a patient based on their assessment,” says Stroupe.
2. When you crave expert holistic-health guidance
One of the most notable ways APRNs differ from MDs is the amount of time they spend with patients, enabling them to cover so much more ground than is typical during an appointment with a physician. “Our appointments with patients are probably about 50% longer than a physician appointment, if not more, because we’re going to look at the whole patient head to toe and answer all their questions, every time they walk in the door,” says Stroupe.
3. When you need a prescription
Unlike registered nurses, APRNs can prescribe medications, the same medications as a physician, as well as medical devices, durable medical goods such as walkers and wheelchairs, and other equipment and supplies.
4. When you’re due for a routine exam or immunization
“There is really no wellness exam for routine preventative care that cannot be done by an APRN,” says Stroupe. Pediatric newborn exams, annual physicals for men and women, women’s wellness exams including Pap smears and breast exams—APRNs in full-practice states do them all, as well as immunizations.
In fact, these types of preventative appointments are central to their training, depending on their role and specialty. “Family nurse practitioners are taught from the beginning to do full head-to-toe assessments, not just problem-focused assessments, so we can catch problems early,” says Stroupe. “Then we can take a more holistic approach and say, ‘You don’t have high blood pressure yet, but you’re going to unless you make some diet and lifestyle modifications, so let’s see if we can keep this under control.’”
5. When you need prenatal care
All APRNs can oversee the general wellness of moms-to-be, including both preconception and prenatal care. But one particular subset of APRNs—certified nurse-midwives—have special certification in women's gynecological health and prenatal and postnatal care. Certified nurse-midwives do everything from family planning to delivering the baby unless it’s a complicated pregnancy or cesarean section. Remember, there’s a difference between a midwife and a certified nurse-midwife—nurse-midwives have a nursing background.
6. When you’re dealing with a chronic illness
“This is where the majority of our training comes in,” says Edward Briggs, MS, DNP, APRN, a family nurse practitioner in Florida. He notes that chronic disease management is core to a nurse practitioner’s curriculum as defined by the American Association of Colleges of Nursing. As a result, an APRN’s expertise is comprehensive, starting with making an initial diagnosis of a disease like diabetes or hypertension, and then carrying through prescribing a treatment plan, monitoring your progress, and adjusting the plan as needed—just as a physician would do.
“If the condition becomes complicated and we’re having trouble managing it, I’ll refer the patient to a specialist like an endocrinologist or cardiologist,” says Briggs.
To ensure greater access to health care by safe and qualified providers, support the bill in your state by clicking here.