Patients like Ella Highsmith, whose recent clinic visit included office time with pharmacist Evan Sisson and fourth-year pharmacy student Nathan Smith, don't seem to mind.
"My treatment has been consistently good," said Highsmith, a longtime patient of the center.
Sisson, also an assistant professor in the Virginia Commonwealth University School of Pharmacy, said pharmacists are coming from behind the counter and into patient-care rooms alongside physicians and other providers.
National health-care reform, which expands coverage to an estimated 30 million more people, may mean using more non-physicians, including nurse practitioners and physician assistants, as primary-care providers. But those non-physicians continually have pushed for less oversight.
"Nobody in this country is talking about having too many physicians," said Elizabeth Carter, who directs the Virginia Department of Health Professions' Healthcare Workforce Data Center.
State work-force data and demographic trends, including aging baby boomers and retiring physicians, suggest the need for primary-care providers will only grow, Carter said.
But medical students, burdened with student loan debt, increasingly have turned to higher-paying specialty care.
For nurse practitioners and physician assistants, however, "their move toward primary care has been pretty significant," Carter said.
About 5,100 nurse practitioners and 1,700 physician assistants had licenses to practice in Virginia as of June 30, 2008, according to the Virginia Department of Health Professions.
In comparison, there were about 3,900 nurse practitioners and 600 physician assistants as of June 30, 2000.
Use of practitioners and physician assistants has grown in recent years as the walk-in clinic industry has increased. Most of the clinics use nurse practitioners and physician assistants who treat such illnesses as strep throat and ear infections and provide common vaccinations.
CVS Caremark Corp., which owns about 500 MinuteClinics, including six in the Richmond area, said this month that it plans to double the number of its walk-in clinics nationally during the next five years in response to health reform.
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In Virginia, nurse practitioners and physician assistants can practice under the supervision of a medical doctor.
It's that way for a reason, said Dr. Daniel Carey, president of the Medical Society of Virginia. Carey, an interventional cardiologist in Lynchburg, works alongside nurse practitioners and physician assistants.
"The physician community has great respect for their non-physician colleagues in the care team," Carey said. "When you talk about increasing the scope of practice of nurse practitioners and physician assistants as a solution, we have problems with that. They are not acknowledging the significant difference in training."
Physicians, he said, do 12,000 to 16,000 hours of clinical training during medical residencies -- far more than nurses or physician assistants, he said.
"We see the supervisory role as very appropriate," Carey said. "Simply to cut the supervisory relationship and turn out nurse practitioners and physician assistants as independent primary-care providers I think is inappropriate and not in the interest of safety."
Cindy Fagan, president of the Virginia Council of Nurse Practitioners, said Virginia laws keep nurse practitioners from practicing to their full capability.
The law, she said, requires a nurse practitioner with authority to write prescriptions to be "medically directed and supervised by a physician," Fagan said. In practice, that means the physician has to have regular office hours in the facility where the nurse practitioner works.
Exceptions are made for rural areas, where it's often difficult to attract any providers.
Nurse practitioner Tammy Cauthorne-Burnette said because the Montpelier medical practice where she works has a rural designation, she is able to have off-site supervision.
That has worked well for her during the past 10 years. But Dr. Frank Sasser, who has been her supervising physician, is retiring.
"I would have been more than happy to stay on and run that practice," Cauthorne-Burnette said. "I could not find any independent doctor who wanted to work out there."
Medical Society of Virginia's Carey said doctors groups are aware that the primary-care provider shortage has to be addressed.
A better solution, he believes, is to fix the reimbursement system so that primary-care doctors get paid better. National health-care reform legislation has such provisions, he said.
"There are positive things in this health-care bill that will be rolling out in the next 12 months that increase the attractiveness of primary care," Carey said.
At the Center for High Blood Pressure, Smith, the pharmacy school student, and fellow student Alexis Noble see themselves as part of the primary-care team and making a difference.
The two recalled teaching a diabetes-education program. One patient complained his medication was upsetting his stomach.
After asking a few more questions, they were able to find out that the man was taking the medication all at once in the evening. Taken that way, the drug tends to cause problems such as the man reported.
"We suggested he divide it up," Smith said.
"I think it helps health-care professionals understand everyone else's role in the health-care team," Noble said.
"It helps to take the burden off of one prescriber. It helps to utilize everyone's education and thoughts on the patient's health."
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© YellowBrix, Inc. Copyright 1997-2009 Health Reform May Expand Non-Physician RolesOriginally from: http://www.nursinglink.monster.com/news/articles/12215-health-reform-may-expand-non-physician-roles
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