Nurse Practitioners Could Solve Oregon's Primary Care Crisis. Will We Let Them?

Women dominate the increasingly crucial profession. They’ve had to fight for respect.

By Ramona DeNies June 21, 2018 Published in the July 2018 issue of Portland Monthly

Last spring, the Oregon Legislature voted on a sensitive issue: whether to repeal a state statute prohibiting nurse practitioners from performing vasectomies. Advocates of lifting the restriction pointed to a backlog of patients requesting this procedure, one that NPs in neighboring Washington state have performed for the past two decades. Rep. Knute Buehler—an orthopedic surgeon and, in this fall’s election, incumbent Gov. Kate Brown’s Republican challenger—wasn’t happy when the bill moved forward. 

“This sets a dangerous precedent for men in Oregon,” Buehler huffed. Also lobbying against the repeal? Several other physicians and the Oregon Urological Society.

A bit snippy? Perhaps. But to those who have long fought for expanding the scope of and general respect for nursing—the profession that enjoys the public’s highest trust, according to decades of Gallup polls—those oppositional voices struck familiar notes. In the eyes of nursing’s advocates, there are a lot of people who still see the profession as “women’s work,” somehow less technical in the public imagination, more about sympathy than about surgery. But reality check: these days, there’s an increasing chance that your primary care provider—responsible for charting your medical history, prescribing your medications, evaluating your lab results—is a nurse practitioner.

That term designates a range of disciplines and specialties, all considered “advance practice” and demanding study and training beyond that required of registered nurses. Portland Monthly’s peer-vetted lists of the metro area’s top medical professionals encompass NPs who conduct independent practices. In many circumstances, patients can choose to see NPs for primary care needs, just as they can choose physicians. Meanwhile, NPs are playing ever-more-important roles in fulfilling society’s escalating health care demands—a fact not always understood by the public, and sometimes a source of interprofessional tension.

“The profession began in rural areas,” says Diane Solomon, a psychiatric mental health NP based in Portland. “NPs were considered a cheaper way to fill the health care needs of the nation. The fact is that as NPs have grown—we’re practicing everywhere—we’ve had a state-by-state backlash from the medical community.”

Solomon says she’s not the only one who wants the medical community, and Oregonians in general, to recognize just how highly trained NPs are. (Postsecondary education can be more than eight years; some NPs, like Solomon, also have a doctorate in nursing.) At a party a few years back, she recalls Kate Brown, a longtime ally of advocacy groups like the Oregon Nurses Association, identifying gender hang-ups as a barrier to solving Oregon’s primary care shortages. (Oregon, like most US states, meets only about half the primary care needs of its residents.) In Oregon, some 88 percent of nurse practitioners identify as female; among physicians, females constitute just 35 percent.

In the battle to be recognized as primary care options, Oregon NPs can draw on a track record of national leadership. The state was one of the first, in the 1980s, to allow NPs to practice independently. That means Oregon NPs make their own calls when providing acute care, aspirating bone marrow, diagnosing chronic conditions, or puncturing lumbars. In 2013, we became the first state in the nation to mandate pay parity for NPs, requiring insurers to pay the same “code” rate for, say, diabetes treatment (or a vasectomy) that an MD might bill for that same work.

Solomon sees another advantage to the rising profile of NPs in health care: a shift toward relationship-based care—more listening, more results. In this, Solomon says, nursing’s reputation for sympathy wins respect. Some medical schools, like Oregon Health & Science University, have begun to shift training models from “treating the disease” to treating the whole person—much as NPs have historically been schooled.

“Go back to Florence Nightingale,” Solomon says. “She set nursing on a trajectory of meeting patients where they are.”

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