Physicians and Nurses At Odds Over NP Autonomy
By Dr. James Palermo // January 13, 2014
FMA: CARE THROUGH A COLLABORATIVE APPROACH, BUT LED BY PHYSICIANS
Healthcare facilities in Florida and nationwide are gearing up to meet the enhanced demand for primary care physicians that has begun with millions of people obtaining health insurance through the Affordable Care Act (ACA, aka Obamacare).
Nurse practitioners (NP) and physician assistants (PA), frequently called “midlevel providers” or “physician extenders,” play an essential role in providing primary care and in helping to meet the ever-increasing need for more primary care resources.
NURSE PRACTITIONERS SEEK DEREGULATION
Existing Florida law requires NPs and PAs to work under the supervision of a physician.
However, NPs, who are seeking more professional “autonomy,” told the Florida House Select Committee on Healthcare Work Force Innovation in Tallahassee Friday morning that granting them the ability to practice without physician supervision would benefit Floridians by expanding access to primary care for patients.
They argued that primary care physicians are in short supply, so it’s only sensible to make full use of nurses who have postgraduate training
PHYSICIANS AGAINST EXPANDING NP’s ‘SCOPE OF PRACTICE’
Physicians, however, are very reluctant to relinquish control and authority over NPs and provided contrasting testimony about whether the state should give nurse practitioners more authority to provide care.
These types of “scope of practice” issues have historically been highly controversial, and groups such as the Florida Medical Association (FMA) oppose lifting physician-supervision requirements.
Physicians told the committee that NPs were valuable members of the healthcare delivery team and that they agree on the need for new approaches to expand primary care. However, the FMA staunchly opposes giving NPs autonomy and said “the best solution is physicians and nurses working collaboratively in a way that does not jeopardize patient safety.”
Primary care physicians are perceived as the “quarterbacks” of the healthcare team who are responsible for enhancing quality and reducing costs, two hallmarks of healthcare delivery in the post-reform era. Doctors argued that they receive more training than nurse practitioners and that care should be offered through a collaborative approach led by physicians.
SOME LEGISLATORS AND THE FHA SUPPORT REGULATORY CHANGE
Legislative leaders have said they are concerned about a combination of factors, which includes, not only the ACA’s newly insured but also a growing state population, aging baby-boomers and the fact that primary care practitioners are also aging and their ranks may not be adequately replenished, that creates a significant challenge to meeting the increased demands for health care.
Demand for family physicians, general internists and other primary care doctors is also being driven in part by a proliferating number of healthcare service sites, including multi-hospital systems, large medical groups, urgent care centers, retail clinics, free-standing emergency departments, community health centers, government facilities and traditional community hospitals.
In Florida, there are 19,000 NPs, who are officially licensed as Advanced Registered Nurse Practitioners (ARNP). Supporters of a change in NPs’ regulatory status that would provide more autonomy and subsequently easier access to primary care for the increasing demand includes the Florida Hospital Association (FHA).
FMA’S PLAN FOCUSES ON INCENTIVES FOR MORE PRIMARY CARE PHYSICIANS
Rather than grant more autonomy to NPs to practice out on their own, not just as a staff member in a doctor’s practice, the FMA has proposed a five-point strategic plan to address the primary care shortage, which includes additional funding for family practice residency slots, fair pay for family doctors who treat Medicaid patients, new technologies such as telemedicine, and a student loan forgiveness program geared to primary care.
As for NPs, the FMA called for “new business models that expand collaborative relationships.”
The committee will meet three more times prior to the regular session, which starts March 4. This debate, focused on the question: “To innovate, do we need to deregulate?” will continue to hinge on what services that trained doctors and nurses in the appropriate settings can deliver to meet the increasing demands for primary care and ensure safe, high quality healthcare.