Our letter to the Today Show and the American Medical Association
Dear Ms. Katie Couric, Mr. Jim Bell, "Today" Show Executive Producer, and Dr. Edward Hill, AMA President:
I am writing to urge you to rectify the damaging distortions in the segment on "quick clinics" on NBC's "Today" Show on November 14, 2005, regarding the safety of care provided by nurse practitioners. Contrary to suggestions in the segment, nurse practitioners are highly trained, autonomous professionals, and a huge body of research (see http://www.tansandbox.org/faq/apn_md_relative_merits.html) shows that their care is at least as good as that provided by physicians. We urge you to apologize to nurse practitioners on the air, to provide "Today" Show viewers with accurate information about nurse practitioner care, to consult nurses when reporting or speaking about nurses, and to provide a balanced picture of important issues in health care.
On November 14th, "Today" included a short, troubling segment with reporter Janice Lieberman about the recent growth in nurse practitioner-staffed "quick clinics" at U.S. supermarkets and drug stores. The piece did stress that the clinics offer convenience and affordability for basic care that consumers appreciate. Lieberman even got her flu shot on camera. But the item also degraded the "cheap" NP care available at the "quickie" clinics, ignored NPs' vital role in more comprehensive primary care, and suggested that autonomous NP care presents safety risks, relying on a baseless, paternalistic quote from "Dr. Edward Hill." The piece did not allow NPs to defend their care from these sloppy attacks. Instead, the only audible NP speech it offered its audience consisted of an NP, identified only as "Kathy," saying "ready" to indicate that she was ready to give Lieberman her flu shot.
A full analysis of this episode can be found on the Center for Nursing Advocacy's website at http://www.tansandbox.org/news/2005/nov/14_today.html
Though the segment talks to several patients and physicians, it fails to get any comment from the NPs whose care is the subject of the piece. So there is essentially no rebuttal to the scary suggestions that patients may be "putting [their] health at risk," that NPs have "far less training" than physicians, that NPs provide poor quality care and need physician supervision, and that NPs are unable to diagnose, and so can only help when patients already know what's wrong with them.
In fact, as the piece fails to note, NPs typically have six years of college-level training, a four-year bachelors degree in nursing and a two-year master's degree in nursing. And even if NPs did have somewhat less formal training than physicians, that would not mean their care was inadequate. On the contrary, extensive research has demonstrated that NP care is at least as good as that of physicians. The piece provides no evidence, even anecdotal, of any specific problems with the quality of NP care, at quick clinics or elsewhere. None.
In addition, "Today"'s U.S. viewers might never know that the nation's 110,000 NPs actually play a vital role in comprehensive primary care, especially in underserved communities, nor that their diagnostic skills are excellent. As skilled professionals, quick clinic NPs are well qualified to refer patients to other primary care providers when that is indicated. NPs do not need physician "supervision," though some legislation may nominally require that. Because physicians compete with NPs, comments like those of Dr. Hill generally reflect economic self-interest, bias, and/or genuine (if uninformed) concern about patient safety. The "Today" producers should have realized that NPs deserved a chance to defend their work. The inclusion of only physician comment suggests that only physicians are qualified to comment on nursing care--an absurd misconception.
Even the piece's language degrades NP care. Patients reportedly get a "quickie diagnosis on the cheap" in between diapers and toothpaste, the clinic NPs work in "kiosks" (do they sell magazines too?), and they seem to have only first names, as opposed to the esteemed physicians who are addressed as "Dr. ____." We realize that working in a quick clinic means you will have to face comparisons of your care to the surrounding consumer products. But the piece fails to provide balance as to NPs' skill or the importance of their care. At worst, the segment's "cheap quickie" language has overtones of illicit sex. At best, it suggests that NP care is fast, cheap and out of control.
The piece also largely ignores the huge public health benefits of the preventative care at which NPs excel. The quick clinic NPs provide affordable, convenient health screenings and vaccinations. We hear about the 60,000 flu shots, but there is no suggestion that many if not most of the recipients may otherwise not have gotten a flu shot at all, nor any hint that influenza continues to kill tens of thousands in the U.S. alone each year. Vaccinations and screenings have saved millions of lives. And if more people had access to them--such as the 1 in 6 Americans who now lack health insurance--they could save millions more. The quick clinics are not meant to provide all primary care, but they may help many patients get vital care they would not otherwise get at all. Such NP-run clinics may be a promising new basic care model in an often hostile and inaccessible health care system.
Once again, I urge you to rectify the damaging distortions on the November 14 "Today" Show. In the future, please refrain from conduct that works against increased access to basic but vital primary care, and that--by erroneously disparaging nursing care to a broad public--exacerbates the nursing shortage that is taking lives worldwide.
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