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Nurse practitioners say they can help VA with staffing shortages

FILE – The Phoenix VA Health Care Center in Phoenix, Ariz. (AP Photo/Ross D. Franklin, File)

The American Association of Nurse Practitioners says it has a solution for Robert McDonald, the new secretary of the Department of Veteran’s Affairs, which is facing a shortage of doctors.

Hire nurses practitioners who’ve received advanced graduate and often doctoral education and clinical training, it says. And allow the NPs, as they are known, to practice to the full extent of their education.

McDonald has said that one of the key factors in fixing the troubled department will be the hiring of an estimated 28,000 physicians, nurses and clinicians to handle the swell of returning Iraq and Afghanistan veterans, along with aging Vietnam vets who fill the waiting rooms every day.

The shortage of medical professionals was at the heart of a recent scandal over the coverup of long patient wait times.

But it’s a tough task, since federal salaries for doctors are currently 20 percent or more lower than the private sector, depending on the doctor’s focus.

However, base salaries for a nurse practitioner in a veteran’s facility is on average $100,000, competitive with the private sector, according to the AANP.

“The issue is that it doesn’t make sense to prevent NPs from doing everything they are trained to do, especially in a system where they are struggling to have enough doctors,” said Ken Miller, president of the AANP. “NPs are currently one of the fastest
growing professions out there. We could help the recruiting effort and help the veterans.”

The country is also facing a general shortage of doctors, with nearly 30 percent nearing retirement age.

States vary widely on how much physician oversight NPs must have. But currently 19 states and the District of Columbia grant nurse practitioners full-practice authority, which means they can examine, diagnose and treat patients, manage acute and chronic illnesses and  prescribe medications, including controlled substances.

The veterans health administration is currently reviewing its nursing handbook to possibly incorporate changes that would allows NPs to increase their roles, a department spokesperson said. And that change would override what states allow.

Congress recently provided about $17 billion in funding for reforming the veteran’s department, including $5 billion for staffing. Overall, the department told Congress in July that there were almost 46,000 vacancies across the entire veterans’ health care
system, a vacancy rate of 15.5 percent.

In Phoenix, where the waiting-list cover-up at a department medical center turned into a national issue, a whistleblower, Dr. Sam Foote, blamed wait times on a doctor shortage. He also said at a tense hearing on Wednesday that a report by the department’s inspector general appears designed to “minimize the scandal and protect its perpetrators rather than to provide the truth.”

The inspector general’s office cited 40 patients who died while awaiting appointments in Phoenix, but the report said officials could not “conclusively assert” that delays in care caused the deaths.

The AANP’s Miller said 50 years of third-party research has overwhelmingly shown that nurse practitioners are safe, effective and cost-effective providers with outcomes that are equivalent and sometimes better than those of physicians.

But the idea of using NPs is a controversial one, especially among doctors in some states like California, where they have been lobbying – even on Twitter -against letting NPs operate without supervision.