Turf Wars with the Docs

The source of this article is Fierce Healthcare, a daily e-newsletter for health care executives. Here are their comments regarding the recent Institute of Medicine report and the American Medical Association’s response.

The American Medical Association was swift to respond to yesterday’s Institute of Medicine report that called for nurses to take on a larger, more independent role in transforming healthcare in America. By 2 p.m., it had shot out a board member’s response to media outlets. It’s main message: Nurses are not equal to physicians. Besides reinforcing the importance of a physician-led team approach, the statement underlined the difference in education and training between nurses and physicians. The statement issued by Dr. Rebecca Patchin, an AMA board member, notes, “Nurses are critical to the healthcare team, but there is no substitute for education and training.” She goes on to compare physicians’ seven or more years of postgraduate education and more than 10,000 hours of clinical experience with nurse practitioners’ two to three years of postgraduate education and less clinical experience than that of a first-year medical resident. It’s possible the physicians fear the report’s proposals could lead nurses encroaching on their turf and reimbursements. The Institute of Medicine report recommends that CMS reimburse advanced practice nurses–such as nurse practitioners and anesthetists–at the same reimbursement level as physicians, and calls on the FTC to ensure state laws do not overly restrict nurses’ scope of practice.

Not surprisingly, Dr. Marla Weston, CEO of the American Nurses Association, told FierceHealthcare that her group was pleased with the report’s recommendations. In response to the AMA’s comments, she noted that the IOM report was evidence-based and that decades of research show that advanced practice nurses can function independently as primary-care providers. She argued against limiting their practice to whatever could be supervised by physicians. “If an advanced practice registered nurse in a rural community is willing to provide care and a physician is 200 miles away, then we’ve just cut off access to primary care in that community,” she said. “We’re not using nurses to the full extent. They are an untapped resource.”

The medical community, and by that I mean the physicians, needs to swallow a reality pill. If we are suffering a shortage of general practitioners and at the same time are going to offer health care to millions of people that weren’t covered before, we’re going to need a lot of help on the front lines for chronic disease teaching, dealing with the kinds of medical conditions that could be easily treated in an examining room that are now showing up in the ER, and general care. Physicians cannot be counted on to take care of everyone simply due to sheer numbers and that’s where the APNs come in.

But see, it’s about the money. Did you note where the IOM report says that  APNs and anesthetists should be reimbursed the same as the physicians? And that their scope of practice should not be limited?

Apparently the AMA cannot stomach the thought of those nurses – nurses, for heaven’s sake – being paid the same as a physician. The idea of APNs functioning independently appears to be terrifying to the AMA, as if nurses are poised to run roughshod over the medical profession leaving nothing but destruction in their wake.

Obviously physicians have more education and obviously, nurses are not going to be performing brain surgery. Nurses understand their scope of practice and can function quite well independently based on their education and clinical experience. But they have to be allowed to use that background in areas where they are well suited and that means that the physicians must give up some control of their domain.

Face it, you have to scoot over a little, physicians. You need the APNs now. It may take a little getting used to, but in the end you’ll see that having APNs as partners, not turf intruders, will benefit your practice in ways you never dreamed of.

No one’s trying to topple your castle. They’re just asking that you lower the drawbridge.


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