Sandeep Jauhar argued a few months ago in a New York Times’ op-ed that “Nurses Are Not Doctors” and shouldn’t be given the same responsibilities to care for patients.
Jauhar is right: nurses have different skills than doctors, and leveraging these strengths may be the most disruptive, effective way to improve healthcare.
Nurses tend to take into account each person’s unique values, beliefs and fears, and how those should factor into what treatments are recommended. With a doctor, patients get about 23 seconds to say what’s on their mind and the entire visit is often less than 10 minutes. Not nearly enough time to get to know someone.
Nurses, on the other hand, can put in the extra effort to get to know their patients. Even with the additional time spent, they can still save money in the healthcare system by decreasing the time doctors need for each patient interaction.
Dentists provide an excellent case study in how to go about this.
As Medicaid was expanded to include dental coverage over the last decade, a situation similar to today’s primary care shortage emerged. The ratio of patients to dentists increased overnight.
Dentists surveyed their situation, and quickly realized they had an underutilized asset. Hygienists, who were trained in cleanings, X-rays, and diagnoses were only used by two-thirds of dentists—and only with detailed instruction. Instead of holding on to control and rushing visits, many dentists gave hygienists autonomy to take ownership of patient visits and bill Medicaid directly. In doing so, patients received a more personalized experience, hygienists were able to provide direct patient care, and dentists saw their incomes rise about $20,000 per year, mostly attributed to hygienists seeing four or more extra patients per week.
This model provides insight into how doctors could better collaborate with nurses. What if doctors allowed their nurses to accept and bill patients directly while providing an office and oversight on key decisions like diagnoses? They could still grow their practice’s capacity through brief interactions, but patients would get so much more.
This kind of efficiency is of critical importance in the US, where the demand for specialists such as endocrinologists far outpaces supply, with only about 3,000 practicing endocrinologists for a diabetes population of close to 30 million and rapidly growing.
Nurses are well equipped to handle the daily management of diabetes, freeing endocrinologists to focus on the most difficult cases. Yet, instead of taking advantage of this practice during this time of crisis in the healthcare system, some doctors compete against it.
That isn’t surprising per se. During the most disruptive changes, established players often start out dismissive, and in this case doctors may be skeptical about the change. But instead of fighting new entrants, they should look to potential competitors as partners to provide an better service. Doctors can lean more heavily on nurses’ skills in understanding the patient to deliver a much better care experience.
It’s time for physicians to stop trying to argue that nurses can never be as good as doctors. Instead, they should understand their jobs are different and take advantage of what nurses have learned to do well—indeed better than doctors—and develop more effective methods of collaboration to patients’ benefit. In doing so, perhaps they’d succeed in lowering overall costs, increasing their salaries and raising the profile of primary care by solving patient needs.