Physicians, first, please do us no harm

First, do no harm. That's the credo our docs all sign on to, right?

Actually, let's first clear something up about that “docs” business. People with MDs, despite what some of them and all of their lobbies maintain, are not the only doctors in this world. And they are not the only toplevel medical professionals, either.

Dentists, pharmacists, doctors of physical therapy, osteopaths, chiropractors and very, very much, nurses — have both the training and the handson experience to treat many of the ailments physicians do. We would lobby, in fact, for that word — physician — to be the one used for our MDs. Nothing against them — everything for them. They often are first among equals among the dedicated people who take care of our health.

But through their lobbying groups, they are also too often first to go after the ability of any other caregivers who they perceive to be muscling in on their territory, whether allowing some leeway and advances in practice by other medical professionals is good for the public health, or not.

That's why we cringed once again when reading of the reaction the MD lobby has to the latest effort in California to help expand health care through other means, in this case by allowing the highly trained people known as nurse practicioners to better care for us: “Some physicians are concerned the rules will expand the scope of services nurse practitioners provide,” a report says.

Yes, docs. That's precisely what some new state rules will do. And thanks be for that.

As CalMatters reported Nov. 16, “California's nursing agency this week approved rules that will allow nurse practitioners to treat patients without physician supervision. It's a move that aims to expand access to care in the Golden State at a time when workforce shortages plague just about every corner of health care.”

That's right — there aren't enough physicians in this state to adequately take care of all Californians, especially in rural areas. And yet the “doctor” lobby is more interested in protecting its members' loosening monopoly on health care than it is in, well, providing real health care for all.

That's sick.

The vote by the nursing board, CalMatters reports, is one of the last steps necessary to fully bring into practice a 2020 law that will allow nurse practitioners to practice more widely. “Nurse practitioners, who have advanced degrees and training, currently must enter into a written agreement with a physician who oversees their work with patients,” and too often that's a hard paper to get signed.

“If I want to do a mobile clinic in Skid Row, I don't have to be held hostage by paperwork to get a partnering physician who may not have the same desire,” says Cynthia Jovanov, president of the California Association of Nurse Practitioners.

When the 2020 bill was going through the Legislature, the California Medical Association was the biggest opponent, saying that since nurse practitioners have less training than physicians, letting them practice independently might lower the level of care and “even pose a risk to patients.”

Everyone has less training than someone else. Your GP doesn't have, or claim to have, advanced cardiac-care training. That's why she's your general practicioner.

And the new law, authored by Assemblymember Jim Wood, DSanta Rosa, is not exactly opening up some kind of anarchy in the state's health care climate. It says that beginning next month, nurse practitioners who have completed 4,600 hours or three years of full-time clinical practice in California can apply for an initial category of practice in their field independent from a physician. In that first category, the nurses' work must be in a facility where there are physicians to consult with when the nurses have questions.

After another period of intense training and practice, by 2026, some nurse practicioners will be able to apply for a second category of care allowing them to work with less supervision.

Come on, “docs.” Drop your historical opposition to such progress. First, do no harm.