Growth in NP Role Satisfaction May Have Limits

Abstract

he New Year heralds increasing changes for nurse practitioners (NPs) as subscribers to the Affordable Care Act (ACA) begin accessing Tproviders, including NPs, in greater numbers. While there has been a lot of media attention suggesting that NPs will play a bigger role in health care delivery with the new insurance programs, recent research suggests that more than 80% of NPs surveyed report that they do not have any extra time to take on new patients or additional responsibilities; 63% report working at full capacity. Thus, what will be the consequences on NP work and role satisfaction when NPs are already working about as fast as they can? A 2013 survey of 222 NPs found that “99% said they were optimistic about the future of their profession.” The survey concluded that NPs are happy with their role because there were so many positive things influencing their practice: increasing salaries (with an average salary over $95,000 a year), many job opportunities, and increasing political autonomy. NPs have seen an increasing trend with states allowing NPs to practice to the full scope of their education with less supervision by other disciplines. These changes suggest to NPs that their importance and prestige is increasing as they move into more team-based leadership roles. At a time when NPs are happier with their role, the opposite feelings are registered among physicians as they have seen their clinical autonomy and reimbursements decline. Physicians continue to react negatively to increasing intrusion into the way they practice medicine, through restrictive regulations impacting practice from insurance and Medicare/Medicaid. They are very unhappy with the requirements to use electronic health records that have added many hours daily to meet mandated reporting requirements of different payers. They see reimbursements falling and anticipate that political battles over Medicare in particular will drive reimbursement ever downward. The survey on NPs included a comparison of NP and physicians scores on certain questions: 97% of NPs were positive about the future of their profession, while only 13% of physicians were positive. Positive morale of their peers for NPs was at 97% compared to 20% for physicians; 100% of NPs were satisfied with being in their profession, while only 32% were positive for physicians. The consequence is “Physicians are responding by working fewer hours, seeing fewer patients and limiting access to their practices in light of significant changes to the medical practice environment.,” with the result that many physician hours will be lost from the workforce in the next 4 years. While it is not clear how physician data were collected, in reporting on the study, Medscape Medical News concluded “NPs are far happier” than physicians who are frustrated with the continuing direction taken by their profession. While NPs are happier now, what steps can we take to avoid the burnout and frustration faced by our physician colleagues? NPs are not going to be immune to regulations which intrude into how we wish to practice with our patients. NPs will be impacted by protocols and reduced reimbursements resulting from fiscal