Can NPs and Physicians ‘Co-manage’ Primary Care Patients?

Nurse practitioners (NPs) have been providing primary care to patients in the United States for 55 years. Yet according to this recent article from Medscape, the best way to integrate NPs into primary care practice with physicians is still unknown.

NPs and physicians work side by side in numerous primary care practices. However, they aren’t always providing the same services. Models for how NPs are used in primary care vary tremendously. Some NPs carry their own panel of patients, while some provide intermittent care to the entire practice’s patients. Others equally share primary care responsibilities in a model known as co-management.

In co-management, physician and NP share all the work related to the care of their patients, from visits and exams to medication refills and filling out disability paperwork. There are no “physician tasks” and “NP tasks” with this approach.

To investigate the potential of the co-management primary care delivery model, Norful and colleagues analyzed data from available studies of the model and interviewed physicians and NPs who practiced co-management. Four main findings from their study included:

1. NP-physician co-management isn’t possible without NP autonomy. In states where laws or regulations prevent NPs from practicing autonomously, true co-management is a nonstarter.
2. The co-management model requires that NPs and physicians be viewed equally as primary care clinicians and provided equal resources to accomplish day-to-day work.
3. Physician-NP co-management requires effective communication; mutual respect and trust; and clinical alignment/shared philosophy of care, including a similar work ethic.
4. Successful co-management can alleviate individual workload, prevent burnout, improve patient care quality, and increase patient access to care. Having two clinicians familiar with the patient’s history and care was viewed as a major benefit to patients by improving continuity of care.