Reprinted with permission. In New York City, Medicare and eight private health plans have given their enrollees permission to get primary care from a group of nurse practitioners, or NPs, who diagnose, treat, prescribe, refer, and bill very much as if they were M.D.'s. Supporters think the idea of a nurse-run form of primary care has a lot of potential.
Many doctors are dubious.
The New York State Medical Society's chief lobbyist, Anthony Santomauro, sees a threat to the well-being of physicians as well as of patients. The law aside, critics argue that primary care entails subtle diagnostic decisions that physicians are uniquely qualified to make. Her NP, Marlene McHugh, devoted an hour to the initial appointment and recommended a dietary rather than a medical approach to her problem. Two studies seem to bolster her case. Nurse practitioners have long provided primary care to those who might otherwise have gone unserved, such as residents of rural areas, and a 1986 study by the Office of Technology Assessment concluded that the care they provided was equivalent to that offered by physicians.