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Posted by Ishani Ganguli February 2, 2012 07:00 AM
This entry is the second in a series on health professionals who work in the author’s primary care clinic.
If Nurse Practitioner (NP) Jane Maffie-Lee had been born a few decades later, she would have become a doctor. Instead, as an inquisitive Catholic school fourth grader in the early 1960s, she picked up a book series on Kathy Martin, nursing student and sleuth extraordinaire, and decided that she’d become a nurse who wouldn’t repeat Kathy’s mistakes.
It was around the same time that the first formal NP training program in the United States opened its doors to nurses interested in primary care. Today, the career has exploded: nurse practitioners are the most prevalent breed of so-called advanced practice nurses who have pursued a graduate degree and state-certification in areas outside the traditional nurse’s job description. In 2008, 36% of the estimated 158,348 NPs in the United States were working in primary care to manage common illnesses and prescribe drugs.
As for many of the more experienced NPs who practice today, Jane’s path to become a nurse practitioner was a circuitous one, driven by an appetite for the next big challenge.
After four years as a nursing major at the University of Iowa, Jane graduated with the title of registered nurse (RN) and moved to Boston to try out a big city with a reputation in health care. She got her first job at Massachusetts General Hospital’s burn unit at a time when nurses ran the show, and her next one as head nurse on a urology and dermatology inpatient unit. Then she decided that she could make more of an impact on health by taking care of patients before they got to the hospital, so she earned herself a master’s degree in community health at Boston University nursing school.
Jane worked in a few different outpatient clinics and her fascination with human physiology grew. “I felt like there was so much more to know,” she says. Would medical school satisfy her curiosity? By then, in the 1980s, the thought of a woman applying to med school wasn’t so audacious. She checked off her pre-med requirements at Harvard extension school and applied to two programs. But after talking with her new husband—a cardiologist she’d met on the job—about his experience (“It will be a shitty seven years”), she decided that the MD route wasn’t right for her or her growing family.
Her next career move allowed her to work close to home and her three sons: she became the chief operating officer of a community health center. She quickly found that she missed taking care of patients and wanted to act as their primary provider. She went to Simmons College to earn adult and family medicine NP certificates, took her board exams, and today is very happy to call herself a nurse practitioner.
The distinction earned her a wider “scope of practice,” as they say. Individual states decide how much NPs are allowed to practice, whether it’s under direct physician supervision or complete independence; in Massachusetts, patients can now choose NPs to be their primary care providers.
At our clinic, the Ambulatory Practice of the Future, Jane spends four afternoon or morning sessions a week seeing patients, either as their primary provider or to cover for a doctor colleague. Her knack for leadership has earned her a larger chunk of responsibility as the practice’s clinical program director: she spends the rest of her time collecting quality measures for the practice and supervising the nurses and medical assistants.
Across the country, NPs like Jane occupy a growing role in our health care system - as the supply of primary care doctors dwindle, the per capita supply of NPs is projected to increase each year by an average of nine percent. This trend not only represents potential cost savings (full-time NPs earn an average of $83,192 per year, compared to $173,000 for primary care physicians) and a fix for our doctor shortage. It may also be good for patient care: Since the 1970s, researchers have been comparing the health outcomes and satisfaction ratings of patients who see NPs versus physicians. They’ve found that within their areas of qualification, NPs provide equal or in some cases better care than their physician counterparts and often leave patients more satisfied.
One thing is clear: The future of primary care demands that NPs and physicians work together in step. But the relationships, and the turf battles, have only gotten more complex. Even at a place like APF, where teamwork is part of our mission statement and everybody takes turns leading staff meetings, the historical health care hierarchy is difficult to escape.
“I want to practice in the way that the doctors around me are practicing,” Jane says to me with her characteristic frankness. “There still is a sense of doctors driving care.”
Does Jane regret not becoming a doctor herself? Nope. She loves that nurse practitioners can really spend time with her patients, without the same productivity demands that are placed on doctors. “I always thought that nurses can sit with illness in a way but not worry about curing it,” she tells me. “We are trained to be with patients and listen to patients…I think in some ways I was a born nurse.”
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About the authorIshani Ganguli, MD, is a journalist and a second-year resident physician in internal medicine/primary care at Massachusetts General Hospital. She studied biochemistry and Spanish at Harvard College and received her More »
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