Hot Topics in NP Practice
Margaret A. Fitzgerald DNP, FNP-BC, NP-C, FAANP, CSP
President
Fitzgerald Health Education Associates, Inc.
Family Nurse Practitioner
Adjunct Faculty, Family Practice Residency Program
Greater Lawrence (MA) Family Health Center
Editorial Board Member
The Nurse Practitioner Journal, Prescriber’s Letter,
American Nurse Today
© 2009 Fitzgerald Health Education Associates, Inc.
May you live
in interesting times.
© 2009 Fitzgerald Health Education Associates, Inc.
Advances in Health Care
Lifestyle
 Pharmaceutical
 Surgery

© 2009 Fitzgerald Health Education Associates, Inc.
“Routine” angioplasty while Vice
President, now LVAD
© 2009 Fitzgerald Health Education Associates, Inc.
New diseases, new threats
H1N1 influenza A, Dengue Fever
© 2009 Fitzgerald Health Education Associates, Inc.
Helping to create
Chronically
critically ill
 New-form acutely
ill
 Groups who have
not historically
lived in the
community

© 2009 Fitzgerald Health Education Associates, Inc.
Opportunity:
We can look at where we have
come as the NP and PA professions.
© 2009 Fitzgerald Health Education Associates, Inc.
What else happened
in 1965?
© 2009 Fitzgerald Health Education Associates, Inc.

The Medical Board was persuaded to allow
nurses to read ECGs, diagnose lifethreatening arrhythmias, and administer
emergency medications as well as
defibrillation – a revolutionary step at the
time. (www.cornell.edu)
1965
Feminine Forever
Dr. Robert Wilson

Menopause is a "living decay," he
wrote, which often destroys a
woman’s "character as well as her
health." He added, "The
unpalatable truth must be faced
that all postmenopausal women
are castrates. …
© 2009 Fitzgerald Health Education Associates, Inc.
1965
Feminine Forever
Dr. Robert Wilson

A man remains a man until the
very end. The situation with a
woman is very different. Her
ovaries become inadequate
relatively early in life. She is the
only mammal who cannot
reproduce after middle age."
© 2009 Fitzgerald Health Education Associates, Inc.
1965 vs 2010
 Type
2 DM therapy 1965
– Chlorothiazide
– Orinase

About $8/ month in 2009 dollars
– Death within 5 years of diagnosis
© 2009 Fitzgerald Health Education Associates, Inc.
1965 vs 2010

Type 2 DM therapy 2010
– TZD (perhaps)
– Biguanide
– SU or DPP-4 inhibitor or some combination
of insulin secretagogues or insulin
– Statin
– ACEI or ARB or direct renin inhibitor
– ASA

Up to $400-500/ month in 2009 dollars, as little
as $16/ month with 4, $4 per month Rxs
– Living decades post diagnosis
© 2009 Fitzgerald Health Education Associates, Inc.
1965 vs. 2010
© 2009 Fitzgerald Health Education Associates, Inc.
Sound Familiar?

A time of..
– Societal change
– Social unrest
– US involvement in military action overseas
– Desperate need for healthcare providers,
particularly in primary care
– The institution of healthcare insurance plan
that was a source of great debate.
© 2009 Fitzgerald Health Education Associates, Inc.
In 1965…
Dr. Loretta Ford, the cofounder
of the first NP program, and
Dr. Eugene Stead, attributed to
be the founder of the PA
profession, were NOT
concerned about physician
shortage but WAS concerned
about the lack of primary health
care services.
© 2009 Fitzgerald Health Education Associates, Inc.
In 1965..
Both professions had their start.
© 2009 Fitzgerald Health Education Associates, Inc.
What did they all face?
Is this 1965 or 2010?
Opposition for nursing and medicine
 Public misunderstanding of role and
intent
 Consumer acceptance of the role

© 2009 Fitzgerald Health Education Associates, Inc.
NPs and PAs:
Today, by the Numbers

Number of PA
programs

– 140

– 325
Number eligible
to practice in USA
– 72,433

Number of NP
programs

Number reliable
to practice in USA
– 135,000
Sourcewww.aapa.org

Sourcewww.aanp.org
© 2010 Fitzgerald Health Education Associates, Inc.
NPs and PAs by the Numbers

PA
– Average 2009 full
time salary= $93,486


www.aapa.org
NP
– Average 2009 full
time salary= $94,142

http://nursepractitioners.advanceweb.c
om
© 2010 Fitzgerald Health Education Associates, Inc.
Opportunity: Our professions’
salaries are approximately double
that of the average US wage earner.
© 2010 Fitzgerald Health Education Associates, Inc.
Pitfall: We often do not take home a
representative portion of the income we
generate.
© 2009 Fitzgerald Health Education Associates, Inc.
Opportunity
Nice to hear that a new high school
grad is thinking about becoming a
nurse practitioner……
© 2009 Fitzgerald Health Education Associates, Inc.
A recent high school graduate, as quoted
in local Louisville, KY newspaper
I
dream of: becoming a
nurse practitioner….
 and living a life without worry.
 Married, with children and stable
for the rest of my life.
© 2009 Fitzgerald Health Education Associates, Inc.
Pitfall and Opportunity: Our
profession is dynamic.

NP by 2016
– NCSBN Vision
Statement= NPs
as autonomous
providers

NP by 2016

AACN= DNP as
entry degree to
the profession
© 2009 Fitzgerald Health Education Associates, Inc.
Pitfall:
But we still have a long way to go…
© 2009 Fitzgerald Health Education Associates, Inc.
© 2009 Fitzgerald Health Education Associates, Inc.
What is our collective responsibility?
Opportunity: Much legislative work has
been done.
Pitfall: Much needs yet to be done.
© 2009 Fitzgerald Health Education Associates, Inc.
Arkansas State
Medical Board Proposal

Regulation 30 outlines protocols and
responsibilities of physicians and nurse
practitioners who have a collaborative
practice agreement. In the proposed rule,
doctors and nurse practitioners must
provide its method of management and
protocols of authorizing prescriptions to the
Arkansas State Medical Board.
© 2009 Fitzgerald Health Education Associates, Inc.
Kaplan and Brown (2006) in NPJ
 Barriers
range from receiving a lower
rate of reimbursement than
physicians to seemingly small acts
of exclusion, such as not being able
to authorize disability parking
permits.
© 2009 Fitzgerald Health Education Associates, Inc.
Pitfall and opportunity
Not enough of us belong to our
professional organizations.
© 2009 Fitzgerald Health Education Associates, Inc.
Opportunity:
Caring for people in need
© 2009 Fitzgerald Health Education Associates, Inc.
The US Uninsured

No health insurance
– 46.3 million Americans
– 15.4% of the population

Gaps in insurance during 2009
– 60 million Americans
– 1 in 5 of the population

Source- Cohen RA, et al "Health insurance coverage:
Early release of estimates from the National Health
Interview Survey 2009" NCHS Brief 2010.
© 2009 Fitzgerald Health Education Associates, Inc.
USA Estimated Consequences
of No Health Insurance

Estimated 45,000 people die annually in
part because they lack health insurance
and healthcare
© 2009 Fitzgerald Health Education Associates, Inc.
NP and PAs (APCs)=
Growth industry
Pitfall:
Have we “flooded the market”
with NPs and PAs?
© 2009 Fitzgerald Health Education Associates, Inc.
Strength in numbers
Do the math!!!

NP and PAs
educated as PCP,
anticipated yield
per annum
– ~3500 +
2500= 6000

Potentially 6000
new primary care
providers per
annum
© 2009 Fitzgerald Health Education Associates, Inc.
Opportunity:
We have caught
the eye of people in power.
© 2009 Fitzgerald Health Education Associates, Inc.
Patient Protection and
Affordable Care Act
$15 million for the operation of 10
nurse-managed health clinics that help
educate nurse practitioners
 $5 million for states to expand their
primary care workforce by between 10
and 25 percent over a decade
 $168 million for more than 500 new
primary care physicians by 2015

© 2009 Fitzgerald Health Education Associates, Inc.
Donna Shalala, former
Secretary of Health and
Human Services
“NPs are going to be key to health care
reform and must be at the health care
reform tables.
 “If you look at where our big costs
are—chronic care management—that’s
where you’re going to see nurses and
physician assistants.”
 “It’s a solution in plain sight.”

© 2009 Fitzgerald Health Education Associates, Inc.
Pitfall
Whose pie is it, anyway?
© 2009 Fitzgerald Health Education Associates, Inc.
Opportunity: Plenty of pie!
 Old
thought
– We are taking work (therefore income)
from other healthcare providers,
especially physicians.
 New
thought
– We are creating opportunities to provide
healthcare for populations that had no
care or have not previously existed.
© 2009 Fitzgerald Health Education Associates, Inc.
So we need to…
Restate our argument.
 We are not replacing physicians.
 We are caring for people in need.
 This is an opportunity that will take
many forms and be influenced by a
number of factors.

© 2009 Fitzgerald Health Education Associates, Inc.
We are operating from a state of
strength, caring for people of great
need. We are not simply “filling in”.
For many people, in many
places, we ARE healthcare!
© 2009 Fitzgerald Health Education Associates, Inc.
May you live in interesting times.
May you come to the
attention of those in authority.
© 2009 Fitzgerald Health Education Associates, Inc.
May you find
what you seek.
© 2009 Fitzgerald Health Education Associates, Inc.
End Presentation



Thank you!
peg@fhea.com
www.fhea.com
© 2009 Fitzgerald Health Education Associates, Inc.