Why doctors need collaborative agreements with nurse practitioners
The Pennsylvania Medical Society strongly disagrees with a recent Morning Call op-ed (“Your View: Why Pa.’s nurse practitioners should have more autonomy”) that calls for eliminating collaborative agreements between certified registered nurse practitioners and physicians.
Author and nurse Kim Jordan said she supports cur- rent legis- lation that would remove collaborative agreements, in part, because nurse practitioners have been unable to find or afford to pay for them.
To remedy concerns for the nurse practitioners who choose to practice independently, The Pennsylvania Medical Society proposed to support limits on how much physicians can charge for collaborative agreements.
What The Pennsylvania Medical Society cannot compromise on is the total elimination of collaborative agreements.
Physicians and nurse practitioners are neither professionally equivalent nor interchangeable. A collaborative agreement with a physician is not a burden, but rather an assurance of greater expertise immediately available in the care of patients.
Nurse practitioners deliver excellent care while working within the health care team, but they do not have the same training as physicians, especially when it
comes to treating patients with complex medical needs.
The practice of medicine, compared to nursing, is akin to knowing the difference between a horse and a zebra when one hears hoof beats. Recognizing the subtle differences between symptoms, especially for patients with complex medical histories, is often the reason serious ailments are misdiagnosed or treatments are delayed.
Nurse practitioners have as little as 500-750 hours of clinical training, with doctors of nursing practice completing an additional 1,000 hours.
Compare that to the 12,000 to 15,000 hours of supervised, collaborative clinical training that physicians need before they practice independently.
In addition, while medical schools have a rigorous standardized curriculum for medical students, some doctors of nursing practice programs are 100% online and vary between programs. The immense benefit of hands-on training cannot be replaced through online learning.
Expanding the scope of nurse practitioners has been championed as a way to decrease health costs. But some studies have shown it may actually increase the cost of care due to nurse practitioners making poorer quality referrals to specialists, ordering more diagnostic imaging studies, and writing more prescriptions than primary care physicians.
In fact, 28 states don’t have nurse practitioner autonomy and their health care systems are working well. And, the largely western states that have removed collaborative agreements still struggle with access-to-care issues.
While more needs to be done to address a lack of health care professionals in rural and underserved areas, data shows that removing collaborative agreements for nurse practitioners has not been a silver bullet.
According to data from the American Medical Association’s Workforce Map, Pennsylvania has more nurse practitioners in the state’s 10 least-populated counties than does Iowa, Arizona, Maryland, West Virginia and New Mexico — all states that no longer have collaborative agreements.
Pennsylvania: 1 CRPN for every 1,401 residents in 10 least-populated counties
New Mexico: 1 CRNP for every 1,434 residents in 10 least-populated counties
Maryland: 1 CRNP for every 1,454 residents in 10 least-populated counties
Iowa: 1 CRNP for every 1,596 residents in 10 least-populated counties
Arizona: 1 CRNP for every 1,807 residents in 10 least-populated counties
West Virginia: 1 CRNP for every 1,817 residents in 10-least populated counties
Pennsylvanians living in rural and underserved areas deserve equal access to high-quality care, which I believe involves physicians and nurse practitioners working together.
Dr. Danae Powers is president of the Pennsylvania Medical Society. She is a practicing anesthesiologist who resides in State College.