JMK2005 said:
We thinkst it suckist... hehe
Thank god for SDN!
Anyway, I've followed this thread with much interest. I cannot contribute any more insight; it seems that there are quite a few people here who are much more well informed than I am on this particular subject. Despite my inability to bring some closure to this conflict, I'll nevertheless throw in some more opinion.
The advanced practice nurse is an entity that will stick with us for quite some time. Many professional physician societies have authored position statements on this issue, and much confusion still exists. I know ANPs, have worked with ANPs, and have listened to countless debates surrounding their utility. There are several things on which, I hope, most of us can agree:
1. Like it or not, the lack of access to primary heath care is a primary motivation for the existence of APNs. You just can't get docs to spend three years in residency, accrue thousands in debt, and then make them practice in a less than lucrative clinical setting. APNs have far less debt at the end of their education; once let loose in the healthcare setting, medicare reimburses them at approximately 80% of physician services.
2. APNs currently function as physician-extenders. In the emergency department setting, there is simply not enough providers to diagnose and treat patients with minor complaints. Nearly every busy urban or suburban ED employs APNs or midlevels to assist with the ever increasing case load.
3. APNs do enjoy a certain degree of independence. When these strategically and politically motivated peeps began requiring masters level degrees, they lobbied state boards for a "license." This distinguishes them from PA's (mere 'assistants') and outlines the future foundation for independent practice. Currently, APNs are still limited by protocol and physician oversight.
Ok, you might say. So what? Where is the controversy? The problem is that secondary gain is alive and well. APNs and the nursing leadership have excellent political clout and representation. They lobby congress with the apparent benefits of lower provider costs and increased health care access. The crazed ambitions of some APNs, however, are less than subtle. In many states, there is discussion about having midlevels qualify as primary care 'physicians' on insurance plans. Since a family ARNP's scope of practice is similar to that of your typical family physician, then why all the fuss? I know this paragraph has invoked generalities to emphasize some key points, but it is important to realize where each side is coming from. ARNPs are no longer educated to assist with the delivery of medical care... many schools advocate for total patent management and practice independence. It is not inconceivable that ANPs will achieve parity with primary care physicians in the near future with respect to scope of practice, the oh-so-important title of doctor, and salary. Why is this pursuit of power such a bad idea for those of us on the MD/DO side of the aisle? Those of us who are completing traditional medical degrees have an incredibly high debt burden and continue to face political and economic challenges with reimbursement. An unopposed APN lobby will make it more difficult for physicians to achieve both personal and professional success in primary care fields.
It is vitally important, therefore, to educate our congresspeople about the educational differences between APNs and physicians. Though many mid-levels possess diagnostic and clinical skills comparable to physicians, they are simply not trained in the broad scope of patient care. APNs do not complete residencies and do not suffer through the same amount of preparatory coursework. Biochemistry, immunology, and the thousand other -ologies might not be necessary for the majority of primary care patient complaints. For the zebras and for the medicallly complex patients, however, a physician is best prepared to address mutlifaceted concerns. Any monkey can be trained to insert a chest tube or intubate. To discuss the indications, contraindications, potential complications, and risks of tube thoracostomy, however, is the responsibility of the physician. This entire issue would be non existent if both sides of this aisle were solely concerned with patient benefit. Nurses want more money, power, and prestige for their profession. Doctors, too, have similar aspirations. Until the APN lobby requires four years of rigorous pre-doctoral nursing education and then mandates a minimum of three post graduate years in specialty training, their educational background cannot be considered equivalent. Call the APNs doctor, permit them to manage patients, increase their scope of practice, but do not lobby for the disappearance of primary care physicians.
To conclude, nurses and their advanced practice counterparts are a vital part of this nation's healthcare system and should be encouraged in all educational pursuits. A doctoral-level provider will probably learn at least something that will make the additional years worthwhile. As long as the preparation of the Dr. Nurse professional is not considered equivalent to the training of an MD/DO, there is little problem. Unfortunately, discussion over this issue is far more complex.
Strategies for proper resolution probably revolve around the issues of physician oversight, scope of practice, and reimbursement. Whether they are called, "Dr." in the clinical setting matters little. Just like the current malpractice dilemma, this confusing issue underscores the importance of political action. Doctors must advocate for themselves and educate lawmakers about important differences with respect to undergraduate and post-doctoral education. The AMA,the AOA, and other professional societies must necessarily establish a mutually friendly dialogue between themselves and the nursing profession... a dialogue that has the patient's best interest foremost in mind.
An easier way to bring this dilemma to abrupt closure might be to grant these APNs the same privileges and then charge them the same malpractice rates.
What an ingenious solution! How would the APNs/DrRNs/DNSc's deal with 50-100,000 of annual malpractice premiums?
Always an alternative,
push
