mary medical care and the care of hospitalized patients.
A recent survey among nurse practitioners (NPs) found that an increasing number of physicians are hiring NPs because of their value in a lot of medical procedures (Ventura and Grandinetti, 1999). Physicians who employ NPs are still a minority: only 21 percent of 10,000 physicians interviewed employed NPs in their practice. Pediatricians, cardiothoracic surgeons, OB/GYNs family practitioners and internist are most likely to employ NPs. Cardiothoracic surgeons were the first physicians to recognize the value of NPs, the survey found. Because they do a lot of heart transplants, they find they can rely on NPs to assess vital signs, monitor care, and determine when it is safe to send a patient home much more efficiently than a hospital nurse can.
Younger physicians are much more likely than older ones to employ NPs, as are female physicians and those in more recently established practices. Physicians associated with HMOs are more likely to employ NPs than those with no HMO contracts, according to the survey. Although it was not assessed directly by the survey, it seems that most physicians show no clear preference between NPs and PAs.
In some places, nurse practitioners are setting up practices on their own, independent of physicians (Ventura, 1998). In Manhattan, a group known as Columbia Advanced Practice Nurse Associates (CAPNA) have admitting privileges at one of the city's leading medical centers and have secured contracts with three HMOs to serve as primary care providers with reimbursements at the same rates as physicians. While NPs were originally created to provide service in areas where doctors were scarce, they are rapidly becoming accepted everywhere, and the Department of Veterans Affairs issued a policy statement encouraging the use of NPs, saying the could provide up to 80 percent of patients' healthcare needs. The American Medical Association still ...