Nurse Practitioner autonomy (VA)

[BestoFriedo-Todo]

" Most Virginia nurse practitioners could gain the autonomy to practice without a physician’s oversight if Gov. Ralph Northam signs a bill the General Assembly passed with near-unanimous support. " - Rankin , 2018.



- Basically, a bill in VA that allows NP with 5 years of full time clinical experience to practice without physicians overseeing them.

Nurse Practitioners support it.
Doctors disapprove of it.

- The 5 years of full time clinical experience DOES NOT have to be in the same specialty they plan on practicing in.

Lets discuss.

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[Deleted member 737595]

 

[Saifa]

Buerhaus said the quality of care provided by nurse practitioners has compared favorably to doctors in hundreds of studies.

“The vast majority of this evidence shows that nurse practitioners provided comparable and oftentimes better care than physicians,” he said.

 

[Lawpy]

" Most Virginia nurse practitioners could gain the autonomy to practice without a physician’s oversight if Gov. Ralph Northam signs a bill the General Assembly passed with near-unanimous support. " - Rankin , 2018.



- Basically, a bill in VA that allows NP with 5 years of full time clinical experience to practice without physicians overseeing them.

Nurse Practitioners support it.
Doctors disapprove of it.

- The 5 years of full time clinical experience DOES NOT have to be in the same specialty they plan on practicing in.

Lets discuss.

 

[tbonez71]

The Medical Society of Virginia has asked Northam, himself a doctor, to amend the bill to include a provision requiring nurse practitioners to meet their five-year requirement while collaborating with a physician in the same type of practice area, according to Ralston King, the group’s assistant vice president of government affairs.

“If that provision is included, we can drop our opposition to the bill,” he said.

The Virginia Council of Nurse Practitioners, meanwhile, wants the bill enacted as-is and sees the proposed amendment as a step backward, said Cindy Fagan, the council’s government relations chair. The requirement would further limit the physicians available to collaborate with, said Fagan, who added that there’s other language in the proposed amendment the council sees as onerous.
​

It seems ridiculous to want to practice autonomously in a specialty where you have no actual experience or sufficient training. Unless there is something that I am missing about how that would work, it seems like a sketchy thing. 5 years of oversight, after which you are granted full autonomy seems like a good compromise? Not saying it is ideal for either party, but better than the extremes of no supervision ever vs no chance at practicing on your own.

 

[Dantes]

Does this also mean accepting full liability for patient care?

 

[efle]

Not going to comment on whether it's a good or bad thing for VA, but this isn't a new idea. Many states, especially ones with large underserved rural regions, are already allowing midlevel practice without MD supervision. As an example, Iowa does not require physician supervision and in fact does not even require any supervised practice hours before starting to practice unsupervised.

If you're curious about your state, check out: https://www.ama-assn.org/sites/default/files/media-browser/specialty group/arc/ama-chart-np-practice-authority.pdf

Or peek at this infographic:

Spoiler: Infographic

neat

 

[curbsideconsult]

Hasn't this been Quentin Tarantino'd in the med students' forum?

 

[Ms Procrastinator]

Whyyy do we keep doing this? Same discussion, different titles.

 

[BestoFriedo-Todo]

I had no idea this was happening in my state, until l I talked to a NP about it today.
SURPRISINGLY, she was against it. She said she recalled her time when she first started in the ER and that she needed a lot of help. And even after 5 years there were still times when she just needed to consult a physician for further information or guidance. She also mentioned times when physicians had to ask her questions too. However, the process of NP to NP consulting just doesn't sound as effective as physician to NP or physician to physician. 5 years might not be enough for someone who didn't attend med school. Also with the way this bill is structured, the NPs don't even have do their 5 years in the specialty they plan to practice in.

 

[ThetisAntithesis]

Here we go...

 

[Mr.Monster]

Not going to comment on whether it's a good or bad thing for VA, but this isn't a new idea. Many states, especially ones with large underserved rural regions, are already allowing midlevel practice without MD supervision. As an example, Iowa does not require physician supervision and in fact does not even require any supervised practice hours before starting to practice unsupervised.

If you're curious about your state, check out: https://www.ama-assn.org/sites/default/files/media-browser/specialty group/arc/ama-chart-np-practice-authority.pdf

Or peek at this infographic:

Spoiler: Infographic

neat

I gotta say, I find it comical that the South is the only region of the US that has the most states resistant to NP autonomy.

 

[efle]

I gotta say, I find it comical that the South is the only region of the US that has the most states resistant to NP autonomy.

They might just be the slowest to catch on to new trends, rather than being particularly against the idea.

I know the usual SDN narrative is that over-confident NPs are out there lobbying to encroach on MDs and steal away their patients, while offering lower quality care.

I doubt that "NP = MD" is the logic behind most of these state laws though. More like "it's better for this underserved area to have an NP that can write prescriptions, than for them to have nobody with a script pad at all." That's pretty tough to argue against.

 

[Goro]

" Most Virginia nurse practitioners could gain the autonomy to practice without a physician’s oversight if Gov. Ralph Northam signs a bill the General Assembly passed with near-unanimous support. " - Rankin , 2018.



- Basically, a bill in VA that allows NP with 5 years of full time clinical experience to practice without physicians overseeing them.

Nurse Practitioners support it.
Doctors disapprove of it.

- The 5 years of full time clinical experience DOES NOT have to be in the same specialty they plan on practicing in.

Lets discuss.

http://i0.kym-cdn.com/photos/images/original/000/358/764/bb0.png

 

[Psai]

Sounds like they're really getting serious about taking good care of our vets. Nothing says quality like VA nurse.

 

[Neutropix]

Maybe more pre meds would go into primary care if there were more incentive. I know a lot of my scribe friends are going to nursing school with a plan to become an NP ASAP. They're going to get paid to do it too. One of them went straight into a program that's nurse to NP all in one.

 

[Neutropix]

When looking to shadow a PCP I saw one of the offices advertising with the phrase "NO NURSE PRACTITIONERS OR PAs" lol

 

[BestoFriedo-Todo]

Will insurances still reimburse treatment from a NP the same way they reimburse treatment from a physician?
If so, wouldn't NPs be the cheaper way to go, if they had some way of ensuring the quality of care didn't decline beyond acceptable standards?

 

[RNtoMD87]

Sounds like they're really getting serious about taking good care of our vets. Nothing says quality like VA nurse.

I think he means Virginia. Not the place where vets that survived get another chance to go to die for their country.

 

[Cornfed101]

I think this is great. You want to know how to solve the primary care crisis? Have ALL of the primary care providers be NP and PAs. Leave the specialties to the physicians.

 

[deleted480308]

They might just be the slowest to catch on to new trends, rather than being particularly against the idea.

I know the usual SDN narrative is that over-confident NPs are out there lobbying to encroach on MDs and steal away their patients, while offering lower quality care.

I doubt that "NP = MD" is the logic behind most of these state laws though. More like "it's better for this underserved area to have an NP that can write prescriptions, than for them to have nobody with a script pad at all." That's pretty tough to argue against.

When the argument is actually supervised nurse vs unsupervised it’s really easy to argue against unsupervised

 

[BestoFriedo-Todo]

I think this is great. You want to know how to solve the primary care crisis? Have ALL of the primary care providers be NP and PAs. Leave the specialties to the physicians.

But thats where a good chunk of the DOs end up. I'm sure a lot of them would be willing to start taking up specialty roles.

 

[Oso]

Every OP right before they press 'enter' on their keyboard and start the same thread over again:

 

[efle]

When the argument is actually supervised nurse vs unsupervised it’s really easy to argue against unsupervised

I don't follow. Say I'm a patient in some area without a nearby doc. Why is it better for me to have no care, than to have unsupervised NP care? Saying they need to he supervised creates this condition because of the starting premise - no MD there to supervise.

 

[deleted480308]

I don't follow. Say I'm a patient in some area without a nearby doc. Why is it better for me to have no care, than to have unsupervised NP care? Saying they need to he supervised creates this condition because of the starting premise - no MD there to supervise.

First because we’re discussing a situation in which that isn’t normally the case (so rural there are no docs around)....and it isn’t at all true that the NPs would adopt a restriction to not be independent if there were docs willing to supervise nearby

 

[efle]

First because we’re discussing a situation in which that isn’t normally the case (so rural there are no docs around)....and it isn’t at all true that the NPs would adopt a restriction to not be independent if there were docs willing to supervise nearby

It's the appropriate discussion though since it's those states that tend to be adopting independent practice laws- places like New York and California aren't allowing unsupervised practice. What do you think a better alternative is then, saying an NP can practice alone unless an MD moves into town, then they'd have to work under them? Or is the better alternative to let the underserved go without access, to make sure people in the cities can't make the mistake of seeing a solo NP?

 

[deleted480308]

It's the appropriate discussion though since it's those states that tend to be adopting independent practice laws- places like New York and California aren't allowing unsupervised practice. What do you think a better alternative is then, saying an NP can practice alone unless an MD moves into town, then they'd have to work under them? Or is the better alternative to let the underserved go without access, to make sure people in the cities can't make the mistake of seeing a solo NP?

I think there is danger in the premise that “any and all care” nearby is better than knowing you have to travel for properly trained care

But the NPs aren’t at all interested in just working independently in underserved primary care so that entire justification is BS

 

[efle]

I think there is danger in the premise that “any and all care” nearby is better than knowing you have to travel for properly trained care

But the NPs aren’t at all interested in just working independently in underserved primary care so that entire justification is BS

Oh I don't think their lobbying efforts are motivated by low access areas. They're interested in what's good for them, just like the physician lobbies are.

I do think few will travel far to keep on top of their blood pressures or diabeetus chronically though, and I do think that stuff can be managed without a full MD, and so I do think the law can be a good thing for big parts of those states.

 

[BestoFriedo-Todo]

" Yep, I got my NP autonomy and independence. Now I can finally move out to the rural country areas to open my own practice and treat the undeserved at a cost to myself " - NP 2018.

All jokes aside, most of the time that is not the case. They just want more power and independence to practice medicine, without going to medical school, which is cool and all. However, if I was an insurance company, I would take this opportunity to reimburse for much less considering that there is no attending physician signing their charts.

 

[deleted480308]

Oh I don't think their lobbying efforts are motivated by low access areas. They're interested in what's good for them, just like the physician lobbies are.

I do think few will travel far to keep on top of their blood pressures or diabeetus chronically though, and I do think that stuff can be managed without a full MD, and so I do think the law can be a good thing for big parts of those states.

but there is a massive moral hazed the govt takes on when it tells people that seeing an NP "counts" in the same way that being managed by a physician does......it's simply not true that they have the same training and capacity

 

[deleted480308]

" Yep, I got my NP autonomy and independence. Now I can finally move out to the rural country areas to open my own practice and treat the undeserved at a cost to myself " - NP 2018.

All jokes aside, most of the time that is not the case. They just want more power and independence to practice medicine, without going to medical school, which is cool and all. However, if I was an insurance company, I would take this opportunity to reimburse for much less considering that there is no attending physician signing their charts.

except the next step is what they did in oregon which was push for legislation that they couldn't be reimbursed less

 

[BestoFriedo-Todo]

except the next step is what they did in oregon which was push for legislation that they couldn't be reimbursed less

Never heard of that until you mentioned it. So I go to google it.
And I'm shocked that this law actually passed and is currently a real and ongoing thing.

http://www.nursepractitionersoforegon.org/page/news20160225

At that point they've basically won. All the power of a physician without having to go to medical school.

 

[DubbiDoctor]

except the next step is what they did in oregon which was push for legislation that they couldn't be reimbursed less

Physicians should support such legislation if NPs gain full autonomy nationwide. That way physicians could compete against MDs on level playing field, touting their far greater clinical experience and longer duration of training -- and any studies showing better outcomes - to attract patients. If we invest a little in marketing, no one who has the option of seeing an MD/DO will see a NP for their medical needs for the same price.

 

[deleted480308]

Physicians should support such legalization if NPs gain full autonomy nationwide. That way physicians could compete against MDs on level playing field, touting their far greater clinical experience and longer duration of training -- and any studies showing better outcomes - to attract patients. If we invest a little in marketing, no one who has the option of seeing an MD/DO will see a NP for their medical needs for the same price.

well, if we are going with the premise that the govt is protecting people through licensing requirements we should never support NP independence. I'm all for competing against everyone in a complete free for all......but not with the govt somehow pitching that we are interchangeable

 

[neusu]

Would they practice independently in a limited scope of practice?

 

[DubbiDoctor]

Would they practice independently in a limited scope of practice?

Most autonomous NPs seem to do primary care, just like an internist or family practitioner. Some do psychiatry as well: psychiatric NPs seem to have the same SOP as outpatients psychiatrists. NPs are not acting as independent surgeons, oncologists, cardio-thoracic anesthesiologists or other highly specialized physicians. NPs threaten physicians, but they don't threaten all physicians equally. Medical students would be wise to factor in vulnerability to midlevels when deciding on a specialty, obviously along with a number of other important factors. If you're passionate about primary care, go into it, becoming an expert. But you'll likely be competing with NP-led clinics.