The expected surge in newly insured patients through the Accountable Care Act, combined with the nation's growing and aging population, poses a major problem for the health care system: There are not enough primary care physicians to care for all of these patients. The solution, asserts an article in the New England Journal of Medicine, may be to further empower advanced-practice registered nurses. Currently, however, APRNs' clinical boundaries are limited by state scope-of-practice laws, which can restrict their ability to treat patients independently or to prescribe drugs. The Federal Trade Commission and, recently, the National Governors Association, have encouraged states to re-examine their scope-of-practice laws to help increase the number of primary care providers. Physician groups -- mainly the American Medical Association -- have resisted such policy changes, however. Ultimately, the author concludes, real change may come at the practice level where physicians, nurses and other caregivers are freer to move from traditional, hierarchical leadership to situational leadership, in which a physician, nurse or other caregiver may take the lead in a given clinical situation. Read the article.
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