Regarding "Nurses group: AAFP 'out of step' on medical-home leadership":

Discussions about nurse-practitioner and medical-doctor practice almost always come down to who has the most education, the most experience or the longest time being trained. The essential question really should be, "What level of education, experience and length of time in training is optimal for providing a given level of care?" To the best of my knowledge, no one has researched the effect of length of education on patient outcomes, per se. European medical education is not based on the four years of undergraduate and four years of medical education that American physicians receive, yet European primary-care patients seem to be doing quite well. By extension, then, isn't it possible that something other than the 4 + 4 model provides the appropriate level of education, without overdoing it? A nuclear physicist knows a great deal more about the production of electrical energy than a licensed electrician does, but when I need the wiring in my house fixed, I don't hire a physicist. The electrician's combination of knowledge and skill is a better match for my needs. I think our patients would all be better served by moving the debate away from who has the most education and into what education and skill is the best match for primary care and how that education and skill can be gained.

Tamara Zurakowski

Practice Associate Professor

University of Pennsylvania School of Nursing

Gerontological nurse practitioner

Living Independently for Elders

Philadelphia