Comments on: Nurse Practitioners Win First Round In Fight For More Power

By: Chrissyxf

Chrissyxf — Mon, 03 Mar 2014 22:57:41 +0000

I am so tired of hearing all of these arguments. As one of the extremely rare individuals who practiced as both a physician assistant and now as a physician, I was amazed in medical school by how much information I was not aware of as a physician assistant. While physician assistants and nurse practitioners are not the same and have differences in training, they are both considered to be mid-level providers. Time and time again, I have been distressed by the overinflated egos of so many nurse practitioners and PAs who are unable to see their limitations in knowledge. This is not to sat that I have not encountered the same with physicians. Knowing one’s limitations, whether as a mid-level practitioner or as a physician, is perhaps the most important thing any one provider can do to care for his/her patients. One of the main differences in training between physicians and mid-level providers is that physicians, even after graduating from medical school are under the supervision of a more experienced physician for a minimum of three years and in many specialties, 6 to 7 years. Finally, mid-level providers were never designed nor trained to practice as so providers. While they are capable of taking care of relatively simple and straightforward cases which serve the vast majority of patients well, there will always be cases that they will be unable to handle due to a lack of knowledge of underlying pathophysiology.

By: Jacquie

Jacquie — Thu, 20 Feb 2014 22:43:53 +0000

I would like to address some of the comments made. One person reported that their medications had to be changed as the Nurse Practitioner (NP) could not prescribe them. They are talking about Narcotic medications most likely. As an NP in Indiana, I have prescriptive authority to write those medications, but that does not mean that I will allow every patient to have them or keep writing the script for them. Narcotics are meant for short term use. If a patient’s pain is not alleviated in a reasonable time frame, then the underlying cause of pain should be further investigated, not have narcotics to mask it. There are multiple ways, other than narcotics, to address pain issues, and can be as simple as timing of medications. I guarantee that NP’s are not asking to practice as physicians. NP’s may be called doctor as the term is not an exclusive term for physicians. Many spiritual leader have the title of Doctor but they are not physicians. So the lay person should not be confused by a simple term. I also agree that patients need to investigate the person providing medical care to them just as they would check out a mechanic before allowing them to work on their car. I guarantee you that there are physicians in this world that I would not see, as an NP patient, because they do not practice safe medicine. Note that you hear more about physicians getting into legal trouble over their prescribing practice of narcotics more frequently than NP’s. I also assure you that physicians and NP’s are people, just like everyone else. Everyone makes mistakes, thus the checks and balances that are in place to decrease them.

By: William

William — Thu, 20 Feb 2014 15:30:01 +0000

The United State’s biggest single-payer healthcare system – Military Medicine has utilized Nurse Practitioners, Physician Assistants and Physical Therapists to the full extent of their education and training for over 40 years. These “scope of practice” arguments are really about “big medicine’s” loss of hegemony over healthcare. We are now entering an era of collaborative clinical care, where the patient may select/direct their care.

By: Frank

Frank — Thu, 20 Feb 2014 03:44:47 +0000

I’ll spare everyone the argument and present the real issue that Laurie touched upon. MDs supervision/collaboration of ARNPs has everything to do with financial security for the MDs and absolutely nothing to do with the competency of ARNPs. The FMA is upset because now the possibility of ARNPs receiving 100% reimbursement for the work that they actually did completely on their own is clear and apparent. Subsequently, MDs will lose their nice salary they received from work they never did and will have to work more then 3-4 hours a day to make up for it. In closing, FL has one of the highest rates of prescription drug/substance abuse in the nation, but if ARNPs don’t have controlled substance prescriptive authority then there’s only one group to point the finger at…. And they still want to discuss patient safety and competence of ARNPs…?

By: Thomasine S

Thomasine S — Thu, 20 Feb 2014 02:03:42 +0000

I am a nurse practitioner practicing in a rural clinic in New Mexico. This state grants NP’s full autonomy to practice and prescribe independently. Those who feel comfort because a nurse practitioner is supervised by a physician should be aware that supervision sometimes only amounts to an occasional retrospective chart review. A nurse practitioner’s supervision by or collaboration with a physician is determined by each state. There is ample research spanning more than 20 years that supports the safety and quality of care provided by NP’s. Florida has one of the most restrictive environments for NP’s. The state is graded F for access to care because of the restrictions (AANP.) Check the website, all states receive a grade. Florida is a lovely state, but is the last place where I would practice because of the restrictive environment. New Mexico is recruiting NP’s from states like Florida; inviting them here to practice to the full level of their education.

By: Laurie

Laurie — Wed, 19 Feb 2014 22:52:09 +0000

Once again the only complaint against NPs is not the care they deliver, but the schooling. There are remarks that patients don’t want to see a nurse practitioner… But why can’t a patient have a choice. I am a nurse practitioner who does house calls. I have 7 nurse practitioners who service over 1000 elderly patients who can’t get to an office. (No physician is eager to do this job because the reimburse my is horrible). I pay physicians to collaborate in my practice almost $60k a year and yet not one of them
Has ever seen my patients. Yet, I collaborate with doctors and other ARNPs everyday who are
More than willing to assist with questions without me having to pay. The only patients who leave my practice are patients who die and patients I can’t write controlled substances for.
I have a doctorate degree and 11 years of schooling and practice safely everyday. I would like to know how much of a primary care doctors schooling for 20 years ago is impacting his practice now…a primary care doctor doesn’t know how to read X-rays, deliver babies, or do surgery…… But yet their schooling teaches them to do so…. We learn how to practice everyday…..

This current collaboration is simply opposed by physicians because physicians won’t be able to use ARNPs as a source of second income…..
THERE IS NO EVIDENCE THAT SHOWS ARNPS ARE NOT SAFE… Yet there are several studies that demonstrate that ARNPs and physician outcomes are the same…. So really what is the reason for opposing this????

By: No Excuses

No Excuses — Wed, 19 Feb 2014 21:41:43 +0000

I think nurse practitioners do a fine job for family practice type care. However, that being said, I would not want a nurse practitioner who was not supervised by a doctor in any of the specialists’ offices that I use for various things. As for physicians running in and out so quickly, that has not been my experience. Many of them are happy to discuss medication, complications, etc. with me before moving on to the next patient. If they aren’t, I don’t stay with them. Most of my doctors and I have had a patient/doctor relationship for 10 to 20 years or more. I’m happy with things the way they are, and I have no problem seeing a nurse practitioner as long as they are supervised by a doctor.

By: tom

tom — Wed, 19 Feb 2014 18:23:52 +0000

Janet wrote “Does the thought of a nurse practitioner treating you as a doctor worry anyone else besides me?”
The licensed NP is as competent as any physician, for example, take a look at the HIV specialists, who must sit for the SAME examination, regardless of whether they are NP or MD. NP’s, in general, are more empathetic, than physicians:

NP: How is Ms. Jones’ doing today?
MD: How is the amputated leg responding to her antibiotic therapy?

JJ wrote “In the hospital settings Doctors are normally the ones making mistakes to let the RN’s and NP’s be the safety nets to catch them……Just saying!”

I disagree, as one who has worked as a physician. Everyone makes mistakes, especially in the hospital. Watch any episode of “House”, and you will see plenty of errors, by everyone.

Free market: let the public choose!

By: Laura Reyes

Laura Reyes — Wed, 19 Feb 2014 17:40:43 +0000

I’m currently attempting to obtain my master’s degree as a nurse practitioner. Some of the literature I have been reading indicates that there is a push to have entry level nurse practitioners have a doctorate in nursing practice as opposed to a master’s degree. Has this push been considered when initiating this bill?

By: randy

randy — Wed, 19 Feb 2014 16:57:01 +0000

It comes down to choice. If ARNPs go solo and the insurances give the choice to the patient and the patient chooses the ARNP, so be it. If the insurance/payor limits the choices to ARNPs, then the level of care (by definition) is being downgraded (even if the particular ARNP is very competent, which no one knows before hand). Also, if the ARNPs and the insurance can stand alone in court, that will help. But if hospitals will place ARNPs to “work independently” but by protocol have physicians seeing their patients after a number of visits, the ARNPs are just being told they are “independent” when in fact they are being indirectly supervised; in this, case both the physicians and the ARNPs are being exploited by the institution. If ARNPs want to go solo, then physicians should not see their patients unless there is a transfer of care, not just physicians providing a safety net for the ARNPs. The next thing is a referendum: Do the people of Florida want the change, possibly a downgrade, in their care? It could be that the legislators voting “Yes” for this bill are beholden to some interest group intent in making more money at the expense of patient care.
To the person above that says that nurses/ARNPs catch physicians errors, let us reverse the roles. Let us have ARNPs driving and have doctors just “backing them up” and see which one leads to more deaths and worsening situations to the patients. In all cases, it would be the patients that pay with his own life/limb/health the ARNPs’ desire to be physicians when they are not trained thus.

Ciao!