UPDATE 1-Doctor shortage looming? Use nurses, US report says

* Nurses can deliver quality care cheaper

* Expanded education needed

* Nurses can fill forecast shortage of physicians (Updates with AMA reaction, paragraphs 5-6)

By Maggie Fox, Health and Science Editor

WASHINGTON, Oct 5 (Reuters) - Nurses can handle much of the strain that healthcare reform will place on doctors and should be given both the education and the authority to take on more medical duties, the U.S. Institute of Medicine said on Tuesday.

A report from the institute calls for an overhaul in the responsibility and training of nurses and says doing so is key to improving the fragmented and expensive U.S. healthcare system -- President Barack Obama's signature political initiative.

"We are re-creating nursing in America," Dr. Risa Lavizzo-Mourey, president and CEO of the nonprofit Robert Wood Johnson Foundation, said at a news conference.

"We believe that this report and the implementation of its findings is vital to the strength of healthcare in this nation," she said.

But the American Medical Association, which represents about 120,000 practicing physicians as well as students and resident doctors, quickly criticized the report.

"Nurses are critical to the health care team, but there is no substitute for education and training," the group said in a statement. "With a shortage of both nurses and physicians, increasing the responsibility of nurses is not the answer to the physician shortage."

Nurses already often deliver babies, counsel patients with heart disease or diabetes and care for dying cancer patients -- and these roles should be expanded nationally and paid for by both public and private insurers, the report says.

"Nurses have to be full partners with doctors," said Donna Shalala, a former Health and Human Services secretary who helped write the report. She said it should "usher in golden age of nursing" by allowing nurses to practice "to the full extent of their education and training."

DOCTOR SHORTAGE ANTICIPATED

The U.S. healthcare reform law passed in March is expected to add 32 million Americans to health insurance company rolls. Several groups, including the Institute of Medicine, have forecast shortages of doctors to provide care.

Last month, the Association of American Medical Colleges released new estimates that showed 63,000 more doctors would be needed in 2015 than would be available. [ID:nN30276233]

"We evaluated the evidence which has been accumulating now for decades as to the capability of nurses to bridge that gap," said Dr. John Rowe of the Columbia University Mailman School of Public Health, one of the report's authors.

"There have been concerns in the past that nurses could provide the quality and safety for some areas of primary care. The committee concluded that it was very clear from the evidence that nurses can very effectively and safely ... deliver those primary care services."

The United States has more than 3 million nurses, making them the single-largest segment of the healthcare workforce, said the nonpartisan institute, which advises the federal government on medical matters.

It said states, federal agencies and healthcare organizations should remove so-called "scope of practice" barriers that limit what nurses may do.

The U.S. government and non-profit organizations should fund grants and scholarships to allow nurses to further their educations so they can take on bigger responsibilities.

"We really need to use nurses to their full potential," Shalala said.

By 2020, 80 percent of nurses should have a bachelor's degree at least and 10 percent of them should go on to get a doctorate degree, the report recommends. Many nurses now practice with a two-year certificate. (Editing by Bill Trott and Xavier Briand)