Greater autonomy for nurse practitioners
If you’ve had a minor complaint or suffered a slight malady recently, there’s every likelihood you’ve been seen not by a doctor but by a nurse practitioner, who has the ability to make diagnoses and prescribe medication.
No, they do not have the same level of training as physicians, but they are qualified to treat routine medical problems, and offer critical early intervention before they refer complex cases to doctors. And we need more of them – with baby boomers getting grayer and slower of gait, and more patients able to seek the care they need thanks to the Affordable Care Act, many parts of the country are seeing a shortage of doctors and other medical professionals. Nurse practitioners could fill the gap.
Nurse practitioners also tend to charge less for the same kind of basic care a doctor would provide, saving patients and the whole health care system some money.
However, in Pennsylvania and 30 other states, the hands of qualified nurse practitioners are tied by laws that force them to be affiliated with a doctor, and pay that physician a fee. Lawmakers in Nebraska and Maryland recently broke that bond, allowing nurse practitioners to work without the sanction of a doctor, and separate bills in the Pennsylvania House and Senate would do the same here in the commonwealth. Although similar efforts were made in the past and went nowhere, we hope the examples Nebraska and Maryland set will prod lawmakers into action and they add Pennsylvania to the list of states that give nurse practitioners greater autonomy.
According to state Rep. Jesse Topper, a Bedford Republican who is the chief sponsor of the bill in the House, “Nationally, the supply of health providers has not kept pace with demand … Allowing nurse practitioners to practice, without unnecessary burdens and to the full extent of their education and training, would provide much-needed primary care in not only rural areas, but across the entire commonwealth.”
The proposal met with opposition from the physicians who make up the Pennsylvania Medical Society, which argued that letting nurse practitioners strike out on their own would shatter collaborative health care “teams.” Nurse practitioners counter the doctors’ position is more about power and price than team-building. Nevertheless, nurse practitioners have powerful allies in their corner, including the National Academy of Sciences’ Institute of Medicine, the Federal Trade Commission and the American Association of Retired Persons (AARP). In its report, the Federal Trade Commission contended nurse practitioners don’t necessarily require supervision from doctors and increased competition “yields important consumer benefits, as it tends to reduce costs, improve quality, and promote innovation and access to care.”
The Hippocratic Oath that physicians take before they embark on their work asks they “either help or do not harm the patient.” A convincing array of evidence shows giving nurse practitioners greater independence would do no harm and, indeed, would do a great deal of good. And, despite the lack of success it has found in previous legislative sessions, state Sen. Pat Vance, a Republican from Cumberland County, told Allentown’s Morning Call newspaper in March there is a simple reason it could become law this time around: “The impetus to pass it has become greater and greater only because the need has become greater and greater.”