I found the article in the January 2020 issue of Contemporary Pediatrics, authored by Catherine M. Radwan and titled “What’s ruining medicine for pediatricians,” fascinating.1 In summary, Contemporary Pediatrics reported results from a survey sent to 14,422 pediatricians concerning pediatric practice, issues related to practice, job stress, and job satisfaction in 2019 and compared the results with the survey results from 2013. Top 5 challenges facing pediatricians in 2020 also were presented. The challenges included increased pressure to see more patients with shorter visit times, responding to health care reform mandates, competition from urgent care and pharmacy-based clinics, lower third-party reimbursements, and inadequate community resources for children and their families.
What fascinates me about the survey results?
I believe that professional practitioners survey results/research, and especially comparative survey results, offer professionals and professional organizations opportunities to make impactful change, and, in this case, changes that can improve health care delivery for infants, children, adolescents, and their families. I also believe issues that affect one profession, in this case, pediatricians, likewise affect other similar professions, and, in this case, pediatric nurse practitioners (PNPs). Thus, I support conducting a similar survey with PNPs to determine their issues and attitudes concerning current PNP practice post the implementation of the Affordable Care Act (ACA) and hope that results can positively impact pediatric practice.
What are potential PNP practice issues today?
Many PNPs are concerned about changes in practice expectations, which have occurred since the implementation of the ACA, that place significant emphasis on productivity. Pediatric nurse practitioners have been expected to increase the number of patient visits each day, thus reducing the amount of quality time they can spend with parents, infants, children, and adolescents. Many PNPs who practice in school-based health centers also are experiencing similar pressures to schedule a higher number of visits each day.
What is the impact of the electronic health record (EHR) on PNP practice? Many PNPs were practicing pediatric nurses prior to entering a PNP program. Thus, they are familiar with EHR documentation but may be inadvertently affected by the multitude of required history questions and other embedded questionnaires to detect commonly occurring problems such as anxiety, depression, tobacco/alcohol use, and other age-appropriate, potentially high-risk behaviors during the 15-minute health care encounter. Does the fact that many PNPs were and are currently educated within a framework of a relationship-building health care model matter? Does the continuous use of EHR for data collection impact the development and ongoing PNP-patient or PNP-parent relationship?
The demands of effective care and measurement of outcomes through quality improvement projects are another relatively new addition to the expectations of PNP performance and care delivery. Is this movement positively or negatively affecting PNP practice and job satisfaction?
What are the driving forces for creating a survey of PNPs?
To my knowledge, PNPs have not been recently surveyed about their practice issues and attitudes in the ever-changing health care environment. In 2004, I co-authored an article about physician and PNP attitudes and beliefs about collaboration.2 At that time, a major issue was the meaning of collaborative practice. Today, we should be questioning whether PNP beliefs about practice issues are similar to or different from pediatrician beliefs as reported in the Contemporary Pediatrics survey.
Would a survey similar to the one asked of pediatricians but conducted with PNPs provide similar or different results? Would survey results be strong enough to influence the current directions of care on productivity to a changing direction with a re-focus on patient-centered care delivered via the intended meaning of patient-centered care?
The definition and goals of patient-centered care are to empower patients to be active participants in their care. To achieve this goal, PNPs must utilize good communication skills during every patient encounter enabling patients and parents to feel empowered and take charge of their care. Can we actually achieve these goals within a 15-minute patient visit timeframe, while also conducting a history and physical assessment, developing a diagnosis and treatment plan, and providing anticipatory guidance?
Perhaps we should ask PNPs questions about their issues and attitudes about the current state of their clinical practices. In my opinion, it is time for impactful changes to truly deliver quality health care.
1. Radwan CM. What's ruining medicine for pediatricians? Contemp Pediatr. 2020;37(1):28-29.
2. Hallas DM, Butz A, Gitterman B. Attitudes and beliefs for effective pediatric nurse practitioner and physician collaboration. J Pediatr Health Care. 2004;18(2):77-86.