Strategies for provider reimbursement. Should physician pay exceed that of mid-level practitioners?

It is clear that the bitter disputes over power and control in health care have been dysfunctional. The issue of reimbursement equity for nurse practitioners who provide primary care services is only one of many numerous, complex issues--each of which has many underlying and unresolved elements contributing to the dysfunctionality of the contemporary health care system. What is needed is a united effort and interdisciplinary collaboration to: a) address the maldistribution and excessive costs of health care, b) reevaluate all aspects of healthcare including who carries out what functions at what level of educational preparation and reimbursement, and c) redesign a system that is efficient, effective, and economical. It is imperative that individual nurses and physicians as well as organized medicine and nursing work with each other and with other health care providers, payors, regulators, suppliers, and most especially consumers to restructure health care and redefine roles. Doing so requires divestment of self-interests and a dispassionate focus on the mission and goals of the system. Using a conceptual model facilitates analysis of the literature, specific issues, and their impact on the system. However, resolution of the issues and improving the health care system's functionality requires commitment to the goal regardless of personal cost. This is the challenge confronting all of us.