Florida Senate President Opposed To ARNP Autonomy
By Dr. James Palermo // February 27, 2014
BIPARTISAN HOUSE BILL WOULD ALLOW ARNP PRACTICE WITHOUT PHYSICIAN SUPERVISION
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).
Florida House leaders proposed a bill that would expand the power of advanced registered nurse practitioners (ARNP), who have more advanced education and training in direct primary medical care than registered nurses, to address the anticipated shortage of primary-care physicians in Florida.
Last week, the Florida House Select Committee on Healthcare Work Force Innovation, with bipartisan support and a vote of 13-2, approved the bill (PCB SCHCWI 14-01), which would allow advanced registered nurse practitioners to provide care without physician supervision.
ARNPs have long sought the expanded power and argued that primary care physicians are in short supply, so it’s only sensible to make full use of nurses who have postgraduate training.
FORMIDABLE OPPOSITION TO ARNP AUTONOMY
However, 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.
The FMA has staunch support in the Florida Senate.
Don Gaetz (R-Niceville), president of the Florida Senate, presents a formidable obstacle to passage of the bill and came out strongly against the proposal during an interview Friday with The News Service of Florida.
“I’m against it,” Gaetz said. “I think if you want to be a doctor, go to medical school.”
ARNP AUTONOMY ALLOWED IN NEARLY HALF OF THE STATES
ARNPs and House supporters of the bill claim that beyond addressing a shortage of primary-care physicians in the state, sound rationale for passage of the bill is that ARNPs already provide much of the care that the bill would allow, and nearly half the states allow ARNPs to practice independent of a supervising physician.
SENATE PRESIDENT, GAETZ, SUPPORTS FMA PROPOSAL
Gaetz said the state should address primary-care shortages in other ways, such as expanding medical-residency programs to train and keep doctors in Florida, and supports the FMA’s proposal.
Rather than deregulate and grant more autonomy to ARNPs 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.
This 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.
PASSAGE NOT LIKELY THIS LEGISLATIVE SESSION
The legislative debate remains focused on the question, to innovate, do we need to deregulate, and will continue to hinge on what services trained doctors and nurses in the appropriate settings can deliver to meet the increasing demands for primary care and ensure safe, high quality healthcare.
With the power to kill legislation in the hands of Senate President Gaetz, it is very unlikely that this bill will pass in the upcoming legislative session.
When asked if the House proposal is dead in the Senate, Gaetz did not give a direct answer, but said, “I’ll vote against it if it gets to the floor.”