We're asking primary care to control all of this. It's getting too complicated, and its something primary care doctors weren't trained to do. The issue here is new research and a recognition of the reality that specialists can do a better job. Indeed, recent studies have found that patients with certain chronic problems, such as heart disease and asthma, fare better when treated by specialists than when cared for by primary care practitioners. That's something that physicians support.
Cost savings are also the impetus for the use of nurse practitioners.
While the Oxford-Columbia nurses will get paid equivalent rates for equivalent services, their base salary is much lower than primary care physicians. Other dynamics are fueling the nurse practitioner experiment there, however. Says Robert Lewy, M.D., Ph.D. , director of medical affairs at Columbia Presbyterian Medical Center, that the marked lack of primary care physicians at his center means that they need all the help they can get. We have a desperate, crying need for PCPs. In that sense, maybe we're unusual here.