New health-care legislation is upon us. For most Americans, changes in the health-care landscape will be minor and gradual, rather than dramatic.

But for 32 million Americans now without health insurance, the change will be significant. In a few years they'll have, for the first time, a privilege that should be part of every civilized American life: regular, affordable access to a primary-care physician.

Therein lies an important condition: if they can find one.

Primary-care physicians aren't exactly in great supply these days. The demand is great and will be getting more acute. In fact, North Country communities have, in the past, been blessed with family practitioners who came to the area for a specific period of time only because they had signed up as a way to help pay down college debt, not necessarily because of a long-held desire to live and work in rural America.

And today's medical colleges are turning out more specialists than primary-care doctors because practicing a specialty is more lucrative than a family practice.

Simply, it's time to expand the roles of nurse practitioners. More than half of the states are examining just that.

What is a nurse practitioner? She — most of them, but certainly not all, are women — is a registered nurse who has undergone significant advanced education and clinical training. She has a master's degree or a doctorate, and the current trend is toward requiring increasingly higher levels of credentialing. The profession continues to mature, and the training is becoming more systematic. According to the American Academy of Nurse Practitioners, about 135,000 NPs are currently practicing in the United States, and about 8,000 new NPs graduate every year from 325 college and university programs.

NPs practice according to the regulations of the state in which they are licensed. Generally, they work under the supervision of a physician, and their prescriptive privileges are limited. They'd like more independence from physicians and for more authority to prescribe drugs.

Doctors don't want the role of the NPs to change.

Certainly, NPs aren't doctors and don't have the extensive training that physicians do. But we need to rethink how we deliver medicine in this country. Physician assistants have taken on an expanded role in local medical practices. Further, a lot of ordinary health care doesn't require the extensive education and strongly honed skills of a doctor.

Many routine chores and basic medical work can be performed at less expense by well-trained, independent nurse practitioners. In general, NP training includes an emphasis on patient education and personal responsibility for one's own health, something every person could use and probably doesn't get during normal doctor appointments.

It's worth examining further.

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