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A Question for the President

Hershaw Davis
Hershaw Davis, Jr. a BSN student from the University of Maryland School of Nursing, addressed President Barack Obama last night asking how he will improve the country's access to primary care during an ABC News special on healthcare, filmed from the White House.

Davis and Janet D. Allan, PhD, RN, FAAN, dean of the University of Maryland School of Nursing, Baltimore, were among 164 people invited to the town hall forum on healthcare "Questions to the President: Prescription for America" that aired 10 p.m. ET in a special edition of Primetime moderated by Charles Gibson and Diane Sawyer.

Davis and Allan were selected to attend by the American Association of Colleges of Nursing (AACN) along with the association's president Fay Raines and three other AACN members.

In his question early in the show, Davis asked President Obama what the administration plans to do to put more primary care physicians and nurse practitioners (NPs) into the community.

"I work in the ED at Johns Hopkins Hospital [Baltimore], and my major concern is that we have a shortage of primary care physicians and NPs across the country," Davis told ADVANCE and also explained to Obama last night. "If people call [a doctor's office] for an appointment, often they can't get in right away, or for weeks, so they come straight to the ED. This creates a backlog in the ED, and it is straining our healthcare system."

The president responded that his plan for healthcare reform involves providing incentives, such as loan forgiveness, for people to go into primary care. That way, Davis explained people like himself who are planning to become NPs can go into urban and rural areas where primary care is really lacking, and not be "forced to choose between paying back expensive loans and going with their heart and providing healthcare for America."

Davis, who said he was humbled and honored to be able to address the president, said he made sure to specifically mention NPs in his question. "I honestly believe NPs and the nursing profession are ready and able to fill in that gap [in primary care] to provide America's healthcare needs." (One example, the Prescription for Pennsylvania plan crafted by PA Gov. Ed Rendell, relies heavily on NPs to provide many primary care services in the state.)

Janet Allan
Another primary care incentive the president discussed is to change the fee structure in his healthcare reform plan to pay more for services rather than procedures, said Allan, who is also the treasurer of the AACN.

"The president is very aware of the salary gap between a primary care physician and a specialist, which is why more medical students are going into specialty care," Allan said. The current system incentivizes more tests (i.e. more spending) and specialty practices, "which is why the gastroenterologist or cardiac surgeon make so much more money than a primary care physician, and why NPs make less than nurse anesthetists," she added.

Creating a system that pays more for services than procedures will shift the focus of healthcare more toward prevention, which is a positive shift, Allan believes.

"As a nurse, I support moving more toward prevention, health promotion and better primary care as a way of keeping the country healthier, and then also reducing costs," she noted. "Chronic illnesses are what are costing us so much money."

If Allan were granted a question, she said she was planning to ask Obama about educational funding.

"He's clear and the country's pretty clear we have a nursing shortage. What's less well-known is the major reason for it - that nursing programs can't increase capacity because we don't have enough faculty members. This is partially due to a huge salary gap between what a master's- or doctorate-prepared nurse would get in a clinical position as compared to a faculty position," Allan explained, which is anywhere between $40,000-$150,000.

"The federal government can't raise nurse faculty salaries across the country, but I think it can help by incentivizing states to do this," she added. "In the past, on a state level, there have been differential salary incentives to attract people into the field; it happened in the early days of computer technology. So it's something that has to be addressed. It's one thing I'm going to be working on more specifically in Annapolis this year."

Having been a part the first televised healthcare reform discussion Obama opened directly to the American people; Allan said she was honored to be in such an intimate setting with the president. She was also able to shake Obama's hand while he circled the room for 15 minutes after the show ended.

"[Obama] was very impressive in the depth of his responses, and his understanding of healthcare issues," Allan said. "He was asked a lot of tough questions on some very complex financial and care issues, and he had very nuanced responses.

"There was a lot of positive energy in the room; everyone feeling like they were a part of history. I know I was honored to be there and to represent nursing."

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Is the National health Service Corps Loan repayment program pays for students loan in nursing. I just completed my Masters of MBA with a second Masters in Healthcare Management. I would like to teach one day. I am working in the Veteran Hospital in the Intensive Care Unit. I have an Oustanding Student loan for $35,000. I have four kids, a nephew, my husband and I. Financially, I can afford the loan, utilities are higher than ever and my husband and I live from paycheck to paycheck, it's very difficult to maintain our financial situation. Thanks.

Norma Miller,  Register Nurse,  VA HospitalSeptember 05, 2009
Bay Pines, FL


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