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January 5, 2000

Independent Primary Care Practice by Nurse Practitioners

Author Affiliations

Author Affiliation: Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.

JAMA. 2000;283(1):106-108. doi:10.1001/jama.283.1.106

An important article about primary health care appears in this issue of THE JOURNAL. This study by Mundinger et al1 reports an attempt to settle definitively a long-standing policy question: can nurse practitioners in independent practice provide primary health care of the same caliber as can physicians? In previous studies, nurse practitioners and physicians worked in the same practice and had an understanding that the nurse practitioner would consult the physician about patients with difficult problems.2,3 Twenty years later, nurse practitioners have gained the right to practice independently in 22 states.4 In all but 1 of the states that require physician supervision, the supervising physician need not be present during the provision of care. The Balanced Budget Act of 1997 expanded direct Medicare reimbursement to nurse practitioners in all nonhospital sites and removed any requirement for physician supervision.5