I was recently talking with a nurse that works in an emergency department who is a year away from receiving their doctorate in nursing and becoming a nurse practitioner. Specifically, they were talking about the struggles of working with administration at their medical school and how after 5 years of being a student, the university did not know the nurse’s name as most classes are offered online. Furthermore, during our discussion, the escalating cost of nursing school was underscored. The nurse wondered why the medical school was attempting to make getting their doctorate – in order to help others – so incredibly difficult. Similarly, in a terrific blog, NurseTeeny explores the culture of nursing school, including some of her own experiences and expectations of the journey.
Pooja Aggarwal, a fourth-year medical student at the Johns Hopkins School of Medicine highlights the danger of such actions, writing in the Baltimore Sun that with an increasing life expectancy, by 2020 we will likely lack 200,000 physicians. Why then are only 2 percent of medical students choosing family medicine? Well, according to the Journal of the American Medical Association, 40 percent of students generated loans greater than $130,000 by graduation. Thus, the study concludes, “many find a career in primary care out of the question when procedural fields with higher reimbursement rates give the option to earn more than twice the income and work fewer hours.” Great – but that doesn’t help answer the problem of who exactly will take care of those thousands of patients when they get coverage?
A similar concern is shared by KevinMD in terms of the shrinking numbers of med students choosing primary care. He states, “unlike primary care, nursing schools turn away qualified applicants due to the lack of teachers and facilities, something that increased cash from the federal government could help to fix. Such a ready and willing workforce could help fill the gap that many Americans find themselves in when looking for a primary health care provider.” After all, nurse practitioners already perform many primary care duties, among others unique to their profession.
So now I’m wondering why we aren’t hearing more from nurses about what true reform looks like. As KevinMD goes on to state, “nursing’s ‘patient-centered’ model also allows for a personal primary care experience, and nurse practitioners have been proven to lower time on ventilators, complications, and length of stay. And on average, nurse practitioners earn $81,000 a year, almost half of the $160,000 than typical primary care docs (not including the cost of training).”
Hmm. So we have a shortage of primary care providers due to increasing costs and difficulties associated with medical schools making that form of care as a career less attractive. We also have a potential population capable of at least easing or mediating that shortage. Now, this post is by no means proposing a solution; rather providing an opportunity to pause for a moment and open a space for a possibility — to re-think the voice of nurses, the role of medical education, the opportunities for patient care and the need to continue talking often, yet carefully about true reform.
As my conversation continued with the nurse pursing their doctorate, they discussed more of the challenges of working within a system that regulates and scrutinizes their every move all the while working in a profession that is looked at as a stew-down, rather than a cohesive or collaborative unit. As they put it, nurses and doctors provide different forms of care that ultimately benefit the patient when working together. When we finished our conversation, the nurse said they had a taken a 60% pay cut in order to become a nurse. Why? Because for them, the work they do is important and being a nurse makes them proud. Ultimately, their hope is that they will have a role in health care to make sure we do a better job at it for everybody.
Why did you become a nurse?
What role do you think nurses should play in health care reform?
Are reform plans placing enough emphasis on training physicians to serve in preventative roles?