We are fortunate in our country to have the best medical technology in the world. Unfortunately, delivery of this technology, reflected in a worldwide healthcare ranking of 37th, is a disservice to the American people and must be rectified especially when Cuba is ranked 39th.

As provisions of the Affordable Care Act are put in place, a daunting factor is the shortage of doctors who will be needed to provide this healthcare. Statistics from the Association of American Medical Colleges predicts by 2015, we will lack 62,900 physicians nationwide, and this will grow to 130,000 by 2025. This is a dilemma that cannot be quickly nor easily remedied, as it will take decades to catch up. What can be done until then?

We must harness present available resources including nurse practitioners (NP) and physician assistants (PA) to bridge the healthcare gap. Integrating NP and PA expertise is imperative, but this must be done while assuring quality patient care and not bring the American healthcare ranking even lower.

As a member of the Medical Executive Committee (MEC) and Chairman of the Department of Medicine at our small community hospital, I have studied these details and would like to convey to you my findings. Our hospital is not presently considering PAs for staff membership, therefore I will restrict this discussion to NPs.

A nurse practitioner is a registered nurse (RN) who has completed graduate-level education 1-2 years beyond their degree, with some even specializing in fields like pediatrics. Typically, they provide primary care in an outpatient setting like a clinic or medical office under the supervision of a doctor. For years, qualified RNs have moved forward attaining an advanced degree as a NP allowing better and complete care to our patients. So what is the problem?

Hospital administrators now want NPs to take care of inpatients, but obviously, these patients are much sicker than those who are outpatient. NPs rarely get training in a hospital setting, and prior to their post-graduate degree, RNs are taught to follow and implement physician orders, not to develop nor manage a medical care plan.

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