Instructions: Each reply must be at least 450 words. Each reply must include at least 2 peer-reviewed source citations, in current APA format. Each thread will also require integration of at least 1 biblical principle.

Discussion #1

Matthew 9:12 states "But when Jesus heard this, He said, "It is not those who are healthy who need a physician, but those who are sick." This sentiment has shifted in current times due to the proven benefits of preventive treatment. The care of a physician is mostly sought out once someone is sick and needs medical attention; however, maintaining regular visits with a primary care physician can help to prevent many illnesses from occurring.

Shi and Singh state that "demand for physicians continues to grow faster than supply. Leading to a projected shortfall of between 46,100 and 90,400 physicians by 2025" (Shi & Singh, 2017, p. 88). As the demand for physician's increases, the health care delivery system has had to create and employ an increasing number of supporting roles to assist physicians in providing care.

Two of those roles are Nurse Practitioners (NPs) and Physician Assistants (PAs). These two roles work collaboratively to support physicians in providing care to patients in primacy care and specialty care settings. In primary care settings, patients are often given the option to be seen by their physician or their physician's nurse practitioner or physician assistant. Cooper states that "studies had shown that NPs and PAs could deliver 70% or more of the office-based primary care and, thereby, substantially increase the efficiency of generalist practices" (Cooper, 2007).

Often times NPs and PAs are easier to get appointments with and provide the same care as the physician. In hospitals, nurse practitioners and physician assistants "can prescribe narcotics, undertake procedures, and direct patient care" (Hooker, 2006). Nurse practitioners and physician assistants work as part of patient care teams in hospital settings and can be employed by either the doctor they are supporting or the hospital itself.

The roles of nurse practitioners and physicians in hospitals is expected to increase in the future due to the impact of the 80-hour rule enacted by the Accreditation Council for Graduate Medical Education in 2003. This rule limits the average working week for medical residents to eighty hours. Institutions who do not comply with this rule face losing their accreditation (Hooker, 2006). This has resulted in many hospitals hiring an increased number of nurse practitioners and physician assistants to fill staffing gaps.

Nurse practitioners and physician assistants are required to undergo similar training programs in order to practice medicine. The current average length of a nurse practitioner education program is 26 months.

Education programs for physician assistants average 27 months (Hooker, 2006). The majority of nurse practitioner programs allow for part time enrollment, while physician assistant programs primarily require full time enrollment. Each year nurse practitioner programs graduate an average of 6,552 students; which is a decrease from the average of 8,200 in previous years. On the other hand, physician assistant programs have seen an increase in the average number of graduating students. In 1998 the average number of graduates from PA programs was 4,261. By 2005 this number had increased to an average of 4,644 (Hooker, 2006).

The influx in the usage of nurse practitioners and physician assistants has been an important development in medical labor. The roles of these two has expanded in recent years to assist with the growing shortage of physicians in primary care and hospital settings. Both can be trained in a considerably shorter time than doctors and can offer comparable levels of care. I believe the future will see even more nurse practitioners and physician assistants in practice; especially in rural areas where the shortage of health professionals is expected to be the greatest. The benefit of these two roles to patient care is substantial.

References:

Cooper, R. A. (2007). New Directions for Nurse Practitioners and Physician Assistants in the Era of Physician Shortages. Academic Medicine, 82(9), 827-828.

Hooker, R. S. (2006). Physician assistants and nurse practitioners: The United States experience. Medical Journal of Australia, 185(1), 4-7. 

Essentials of the U.S. health care system. Burlington, MA: Jones & Bartlett Learning.

Discussion # 2

Shi & Singh advises health professionals are among the most diverse and well educated in comparison to other labor groups (2016). There are a variety of disciplines and associated professionals within health care settings. Although physicians play a leading role in the delivery of health care, nurse personnel integrate with physicians to create a system for optimal care solutions. The distribution of care to the sick is primarily managed between physicians and nurses. The roles between the two professions are fully engaged when it comes to caring for the sick yet variables in educational and training requirements, career paths and practice environments distinguish the two fields.

Requirements for becoming a physician or nurse professional varies by state and/or disciplines. All states require both physicians and nurses are licensed before entering the practice of medicine and care respectively. Physicians are responsible for evaluation, diagnosis and treatment of health problems.

Physicians must graduate from an accredited medical school with a doctorate of medicine (MD) or osteopathic medicine (DO), successfully pass a national board exam and complete a supervised residency or intern program. Some residencies may last up to 6 years following medical school (Shi & Singh, 2016). Although the education and training track is duly scaled for physicians, nurse professions must also complete levels of arranged education and training.

Nurses serve as major caregivers in a variety of health care settings addressing the physical, mental and emotional well-being for the sick and injured. Like physician licensure conditions, states require that nurses are licensed and well trained before care is practiced. As a practicing nurse, one must graduate from an approved nursing program (ranging from diploma, associate or bachelor degree) and successfully pass a national exam. Most practical nurse programs include both classroom study and supervised clinical experience (Shi & Singh, 2016).

Clinical placements are important in the learning processes of nursing students. Certain setting such as nursing homes settings has been found to require more work to ensure students develop the appropriate context and influence their learnings (Berntsen, Bjork, Grethe & Hestetun, 1999). Unlike physician, nurse programs vary with from program to curriculum requiring between 1 to 5 years. These programs are made available by colleges and universities nationally. The career path and opportunities available for physicians and nurses vary based upon the specialty and basis or approach to treatment.

Physicians are categorized as either generalists, specialists or hospitalists (Shi & Singh, 2016). Physicians trained in general practices are considered primary care or generalists. Specialists are physicians who focus on specific systems or diseases, requiring a certification in the specialization area.

There more common specialties are - anesthesiology, cardiology, dermatology, internal medicine, neurology, obstetrics and gynecology, ophthalmology, pathology, pediatrics, psychiatry, radiology and surgery (Shi & Singh, 2016). Hospitalists seek to decrease overall cost and length of stay patients spend in the hospital. In contrast to physician categories, nurses can prepare to function as a registered nurse, licensed practical or vocational nurse, and/or advanced-practice nurse based on the degree or education level and training (Shi & Singh, 2016).

The interaction between generalists and specialists is essential for patient care; however, financial and organizational changes pertaining to American medicine is causing tension affecting physician-physician relationships (Pearson, 1999). Although specialty settings are organized based upon physician certifications, advanced-practice nurses have accessibility to certification in 4 areas of specialization - clinical nurse specialist (CNS), certified registered nurse anesthetists (CRNAs), nurse practitioners (NPs) and certified nurse-midwives (CNMs) (Shi & Singh, 2016). There are a variety of settings staffed by both physicians and nurses.

Most physicians are office based in private practices with physician partners and clinical employees. Physicians can also work in hospitals, federal government agencies, public or community health clinics, schools or prisons. In comparison, nurses also work in a variety of health care settings.

Nurses are often classified based on the settings in which they work. Clinical environments available to nurses include private-duty, hospital, long-term care, public health, medical office and occupational health (Shi & Singh, 2016). Active physicians in medicine continue to rise and grow in physicians to population ratio within the United States (Shi & Singh, 2016). Since World War I, the nurse profession makes up the largest group of health care professionals (Shi & Singh, 2016).

It's amazing that we live in a society who continue to care enough to dedicate their lives to health care for missionary or professional reasons. Matthew 9:12 passage reads, ‘On hearing this, Jesus said, "It is not the healthy who need a doctor, but the sick'. These words from Jesus simply speak to the need physicians and nurses offer in this diverse world.

References

Bible Gateway (New International Version Passage). Matthew 9:12.

Bjork, I.T., Berntsen, K., Grethe, B. and Hestetun, M. (January 2010). NCBI.

Nursing students' perceptions of their clinical learning environment in placements outside traditional hospital settings.

Principles of Generalist-Specialist Relationships. (Suppl 1): S13-S20.

Shi, L., & Singh, D. A. (2017). Essentials of the U.S. health care system - with access (4th ed.). Burlington, MA: Jones & Bartlett Learning.