Nurse practitioners rise

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KENNETT SQUARE (AP) -- Marguerite Harris and her staff of eight provide prenatal care and child immunizations, write prescriptions, and diagnose and treat ailments from diabetes to the sniffles.

Though it may sound like a typical doctor's office, no one on staff at Project Salud is a doctor. The medical center is run by nurse practitioners -- registered nurses with specialized training and advanced degrees -- whose numbers have risen from 30,000 in 1990 to 115,000 today.

Increasingly, patients are being treated by health care professionals with N.P. after their name instead of M.D. or D.O. Nurse-managed primary care centers such as Project Salud have increased to about 250 nationwide, from just a few 15 years ago.

"We've come a long way since the early days, the knock-down, drag-outs with doctors who thought we were overstepping our roles," said Miss Harris, a nurse practitioner at the Philadelphia-area medical center since 1974.

The change is attributed to factors that include a drop in the number of doctors choosing primary care as their specialty. The reduction is expected to continue.

The American College of Physicians cited medical school surveys showing that from 1998 to 2005, the percentage of third-year residents intending to pursue careers in general internal medicine dropped from 54 percent to 20 percent. Many new doctors, saddled with high student loans, are choosing more lucrative specialties.

The supply of general practice physicians is falling just as the baby boomer population is aging and in greater need of medical care and nurse-run medical centers are helping to bridge the gap.

Nurse practitioners first appeared about 40 years ago in pediatrics, and quickly expanded into obstetrics and gynecology, family medicine and adult primary care. They can perform many of the duties of primary care doctors such as performing physical exams, diagnosing and treating common health problems, prescribing medications, ordering and interpreting X-rays, and providing family-planning services.

However, some physicians' groups are concerned about the trend.

The American Medical Association (AMA) is against giving full autonomy to nurse practitioners, stating as its official policy position that a physician should be supervising nurse practitioners at all times and in all settings. An AMA spokeswoman said the association would not provide additional comment on its position.

"There is an element within the physician community that gets a little antsy. ... They think it's going to take away revenue and business from them," said Dr. Jan Towers, director of health policy for the American Academy of Nurse Practitioners. "Really, there's more than enough for everybody."