健谈的经济学家

对于我们大多数人来说，我们获得的大多数日常保健都来自初级保健医生。但是有一个有限的初级保健医生，不足以匹配患者的数量，特别是在农村地区。在美国医疗系统中慢慢使用的选项是让护士从业者（NPS）进行初级保健。Peter Buerhaus为“护士从业者：对美国初级保健危机的解决方案”提供了加快这一运动的情况2018年9月，为美国企业研究所撰写。

要设置舞台，这就是主要护理涉及：

初级保健临床医生通常治疗各种疾病，包括高血压、糖尿病、哮喘、抑郁和焦虑、心绞痛、背痛、关节炎、甲状腺功能障碍和慢性阻塞性肺疾病。它们提供基本的妇幼保健服务，包括计划生育和接种疫苗。初级保健降低了医疗成本，减少了急诊和住院的次数，并降低了死亡率。”

以下是初级保健医生短缺的证据：

“美国医学院协会（AAMC）估计，到2030年我们将拥有多达49,300的初级保健医生，而不是我们需要的...尽管数十年的努力，研究生医学教育系统并没有产生足够的初级保健医生来满足the American population’s needs. When geographic distribution of primary care medical doctors (PCMDs) is taken into account, the problem begins to feel like a crisis. In 2018 the federal government reported 7,181 Health Professional Shortage Areas in the US and approximately 84 million people with inadequate access to primary care, with 66 percent of primary care access problems in rural areas."

护士从业者（NPS）已经成为公认的医疗保健专业，除了注册护士之外的额外培训和自主权。以下是：

“用美国护士从业者协会（AANP）的话语：”所有NPS必须完成硕士或博士学位计划，并在其初始专业注册护士准备之外具有先进的临床培训。教学和临床课程在初级保健，急性护理和长期医疗保健环境中制定了NPS，具有专门的知识和临床能力。NPS评估患者，秩序和解释诊断测试，诊断，并启动和管理治疗计划。他们also prescribe medications, including controlled substances, in all 50 states and DC, and 50 percent of all NPs have hospital-admitting privileges. The AANP reports that the nation’s 248,000 NPs (87 percent of whom are prepared in primary care) provide one billion patient visits yearly.

"新方案在主要的初级保健专业中编制——家庭保健(60.6%)、成人和老年保健(21.3%)、儿科(4.6%)和妇女保健(3.4%)——提供医生提供的大部分相同的服务，使之成为医生短缺的自然解决办法。NPs也可以专门从事初级保健以外的工作，在美国，四分之一的内科专业实践都采用了NPs，包括精神病学、妇产科、心脏病学、整形外科、神经病学、皮肤病学和胃肠病学实践。此外，提供相同服务的非医务人员得到的报酬比医生少。医疗保险支付给NPs的费用是医生的85%，而私人支付者支付给NPs的费用比医生少。平均而言，NPs每年能挣105,000美元。

"NPs’ role in primary care dates to the mid-1960s, when a team of physicians and nurses at the University of Colorado developed the concept for a new advanced-practice nurse who would help respond to a shortage of primary care at the time. Since then, numerous studies have assessed the quality of care that NPs provide ... and several policy-influencing organizations (such as the National Academy of Medicine, National Governors Association, and the Hamilton Project at the Brookings Institution) have recommended expanding the use of NPs, particularly in primary care. Even the Federal Trade Commission recognizes the role of NPs in alleviating shortages and expanding access to health care services. Most recently, the US Department of Veterans Affairs amended its regulations to permit its nearly 5,800 advanced-practice registered nurses to practice to the full extent of their education, training, and certification regardless of state-level restrictions, with some exceptions pertaining to prescribing and administering controlled substances."