The contentious debate continues over whether nurse practitioners should have more freedom and be less beholden to doctors. Earlier this month, Pennsylvania lawmakers announced they would reintroduce a bill to loosen the legal ties between them.
According to Morning calltwo senators from the state of Pennsylvania, Camera Bartolotta, a Republican, and Lisa Boscola, a Democrat, will redraft a bill — the first iteration of which was introduced nearly 10 years ago — that would require nurse practitioners to complete a three-year period of 3,600 hours of collaboration with physicians. Nurse practitioners will then be free to provide care independently in their specific areas of expertise.
Currently in 26 states, nurse practitioners have full practice rights.
Cheryl Schlam, nurse practitioner and president of the Pennsylvania Coalition of Nurse Practitionerstold MedCity News that the lessons learned from the pandemic should give lawmakers the impetus to take the bill even further in the Legislature this time around.
During the Covid-19 pandemic, each nurse practitioner was only allowed to be attached to one doctor, compared to two before the pandemic.
“If we’ve proven ourselves during the pandemic with one thing, why can’t we do more good work without further restrictions?” Schlam argued.
In the debate between doctors and nurse practitioners, what is lost is what is in the patient’s best interest, Schlam argues. According to her, the restrictions prevent patients from getting the care they need. Last year, there was a nurse practitioner in rural Pennsylvania in psychiatry, and the two attending physicians she was affiliated with retired. Patients with mental health problems could not be seen until the practice could get two more providers.
“That remained patients no access to care,” Schlamb said.
Meanwhile, doctors counter that nurse practitioners lack the training to work independently. One doctor, Dr. Purvi Parikh, a member of the Doctors to protect patientsan organization that supports physician-led health care said the pandemic has shown that.
“The average nurse practitioner has only 5% of the clinical training that a brand new internal medicine physician or a brand new primary care physician has, [and] that doesn’t even count, you know, people who are in their specialties or people who have obviously been practicing for many years and have that luxury of experience,” Dr. Parikh said.
She treated patients in hard-hit New York during the height of the pandemic in 2020 and said nurse practitioners are working no way than they would even if those restrictions hadn’t been lifted, giving them more autonomy.
“So when this Covid-19 response was happening, the doctor-led teams were still on the ground and there was nothing that [nurse practitioners] they could do more by having that ‘autonomy’ that they couldn’t do before those restrictions were lifted,” said Dr. Parikh.
Another finding during the pandemic was that many nurses who were brought to New York to help during the height of the crisis had no experience in emergency care or infectious diseases, she said. They were still operating under this physician-led team model, so “it almost didn’t make sense to remove the restrictions because they were still able to help and help tremendously, but under the supervision of a physician,” said Dr. r Parikh.
She argued that patient outcomes are worse and access is not improved when nurse practitioners practice independently and pointed to a 10-year a retrospective study from the Hattiesburg Clinic in Virginia, which looked at cost data for 33,000 patients. The study showed increased patient costs when nurse practitioners work independently.
Dr. Bryan N. Batson, co-author of the study and CEO of the Hattiesburg Clinic, told the American Medical Association in its published findings that the additional costs were related to a combination of several factors. These include more test ordering, more referrals to specialists, and more use of emergency departments when NPs practice alone.
Although it has become a polarizing issue, Schlam said it’s not about doctors versus nurses.
“I’m not competing to be a doctor. I am an expert nurse. That’s why we cooperate and escalate when things are out of our scope and we have a cooperative agreement that’s a legal mandate that I do that,” Schlamb said.
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