Why doc­tors need col­lab­o­ra­tive agree­ments with nurse prac­ti­tion­ers

The Morning Call - - TOWN SQUARE -

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.

Danae Pow­ers

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