Morning Read: Nurse practitioners–the new primary care providers?

Highlights of the important and the interesting from the world of health care:

Nurse practitioners–the new primary care providers? As the U.S. faces a well-chronicled shortage of primary care physicians that’s only expected to worsen in coming years, a potential solution (or at least partial solution) is lurking at our fingertips: Nurse practitioners. Yet, as Maggie Mahar writes in a characteristically comprehensive blog post, doctors in numerous states are battling to keep nurse practitioners from infringing on their turf. Despite the fact that nurses receive far less scientific training than physicians, this stance by doctors makes little sense. In fact, as primary care becomes more about coordinating care than medial science, many doctors are essentially overqualified for the position of primary care physician.

There are numerous other reasons why NPs should take on more of a primary care role. For one, they’re paid less for performing the same services than doctors, saving the U.S. health system money. Further, quality of care doesn’t suffer when a patient sees an NP instead of a doctor, according to a 2004 study. Further, since nurses are trained to be more “patient-centric,” many patients prefer the care they receive from NPs, rather than doctors. Still, it’s not just doctors’ groups like the American Medical Association who resist giving nurses the authority to perform primary care services–health plans are hesitant, too, Mahar reports.

But the tide may be turning in nurses’ favor. The Josiah Macy Jr. Foundation, which funds programs designed to improve the education of health care professionals, recently recommended that regulators immediately act to remove legal and reimbursement barriers preventing nurse practitioners from providing primary care. “Dozens” of health organizations signed the paper, though the AMA did not. In any case, it may already be a question of when, not if, NPs begin taking over primary care duties to free up physicians for more complex work.


A look at the “gainer” subculture: One of the beauties of the internet is its ability to bring us in touch with and perhaps better understand small subsets of human culture that many of us would otherwise never notice. In that vein, the Globe and Mail has scoured blogs of “gainers”–that is, people who are fat and just want to keep on getting fatter.  The subculture drew attention last month, when a 600-pound, 42-year-old mother from New Jersey publicly announced that she’s set a goal of rising to a gargantuan 1,000 pounds to become the world’s fattest woman. Like many internet subcultures, sexuality is big part of the gainer experience.

Many involved are fat fetishists or adipophiles, another word for individuals who find fondling an overweight person’s adipose tissue sexually arousing. The New Jersey woman, for example, raises about $750 a week to pay for food by letting such fetishists watch her eat via a webcam. Whatever you think of gainers–and most of us will likely feel that what they’re doing is irresponsible and disgusting, not to mention the public health costs we all share due to rampant obesity–it’s an oddly fascinating subculture that likely wouldn’t have been possible 15 or 20 years ago.

Move over H1N1: H5N1 is back, or apparently it never left. That’s bird or avian flu, as opposed to swine flu (H1N1), which has grabbed far more headlines over the last year or two. Though it peaked in 2006, an infectious diseases expert issued warnings about bird flu at a health conference in Vietnam, NPR reports. The expert says bird flu is still present in Bangladesh, China, Egypt, Indonesia, and just last week two Vietnamese people tested positive for the virus.

“As long as it is present in even one country, there is still a public health risk to be taken seriously,” he said. “We should not forget that it has killed 292 humans, killed or forced the culling of more than 260 million birds, caused an estimated $20 billion of economic damage across the globe and devastated livelihoods at the family-farm level.”

The King of Kong: Lending credence to the observation that today’s doctors increasingly value their free time, one New York plastic surgeon has been crowned the world’s Donkey Kong champion. Hank Chien, 35, scored 1,061,700 points in 2 hours and 35 minutes to break the world record for the video game, American Medial News reports. And it’s likely no coincidence that the record was set by a surgeon.

A clinical study published in the February 2007 Archives of Surgery found a direct correlation between gaming and proficiency in laparoscopic surgery. Researchers said surgeons who played video games at least three hours a week in their past were 27 percent faster than were nongamers and had 37 percent fewer errors, AMN reported.

Photo from flickr user Seattle Municipal Archives