Columbia Dean Visits UT School of Nursing

Mary O. Mundinger, Dr. P.H., dean of the Columbia University School of Nursing, came to Houston on May 5 to deliver the commencement address at The University of Texas-Houston School of Nursing. Dr. Mundinger has been in some demand as a speaker since the publication in January of "Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians," in JAMA, the Journal of the American Medical Association. She was the lead author of the article.

In the study which formed the basis for the article, health outcomes were measured for patients randomly assigned to nurse practitioners or physicians. The patients had initially gone to an emergency room or urgent care clinic. Patient satisfaction, health status, physiologic tests and service utilization were measured over a year, with no significant difference seen between the physicians' and the nurse practitioners' quality of care and treatment outcomes.

Essentially, the JAMA article addressed a much-debated and discussed policy issue: Can nurse practitioners in independent clinics provide the same quality of care as physicians? Dr. Mundinger's study asserts that they can, and do.

"It has raised some controversy," Dr. Mundinger told the TMC News. "There was some criticism of the sample size and the length of follow-up, but we are confident that this study validates earlier studies on the same subject."

The study indicates a fairly bright future for the career of nurse practitioner. In fact, the number of nurse practitioners in the U.S. is expected to increase from 55,000 in 1995 to 106,000 in 2005, while the number of primary care doctors is expected to grow only 10 percent during the same period. Further, the Balanced Budget Act of 1997 expanded Medicare reimbursement to nurse practitioners. A nurse practitioner beginning her/his practice can expect to make half the salary of a beginning primary care physician, $60,000 vs. $130,000.

Dr. Mundinger was asked about the current nursing shortage and if the training of nurse practitioners was in any way harmful to the continued supply of nursing graduates.

"I think we need to ask what is dissatisfying about the career of nursing," said Dr. Mundinger. "Once we can solve that, we'll be better able to recruit. Salaries have risen from the abysmal to mediocre, so we need to do better. In many ways, the job of nursing is very tough, some might say onerous. Inpatients are sicker, but there's great emphasis on a shorter length of stay.

"Coupled with some decline in nursing school enrollment is the aging of the faculty across the country."

- ROGER WIDMEYER

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©2006 Texas Medical Center

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