Leave healthcare decisions in the hands of doctors – Daily Press
A growing number of independent health care providers in the United States are practicing medicine without the supervision of an experienced physician. Many patients are unfamiliar with this trend and sometimes do not know if their own doctor is a real doctor.
Virginia and 22 other states license nurse practitioners to diagnose and treat the sick in a free-standing setting without medical supervision. At a time when healthcare has become so complex, this level of medical practice has resulted in a lower standard of care for some.
For years, physicians have worked successfully with Physician Assistants (PAs) and Nurse Practitioners (NPs) in the same practice location. It is a collaborative approach, with NPs and PAs assessing patients according to their training, while doctors monitoring their skills are available for consultation on complicated cases.
Today, this is a widespread organizational design in many general practitioner and specialist practices. It enhances the encounter with a patient by increasing efficiency and is the best use of the abilities of PAs and NPs.
But for some nurses, membership in a physician-led medical team is not a satisfactory arrangement.
In the last decades of the 20th century, the nursing professional organizations sought legislation to expand their scope of clinical care and responsibilities beyond their traditional role as physician extenders. The goal was clear: to practice independently without medical supervision and to be paid directly for their services.
To achieve this goal, lobbyists put forward the idea that unrestricted nursing practitioners would improve access to health care for underserved rural areas. Additionally, proponents claimed that NPs were less costly and of equal quality to physicians. This dialogue resonated with many politicians.
Federal law grants payments from Medicare to nursing practitioners. Their role has been further strengthened in the Affordable Care Act, and now, nearly 50% of states are licensed for autonomous practice.
However, a state license does not certify that independent nursing practitioners have the same clinical expertise as physicians. No credible studies have been conducted to demonstrate the effectiveness of care provided by nurses in an unsupervised setting.
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Since there is no national licensing exam for nursing practitioners, the criteria for obtaining a license to practice independently vary from state to state.
A major concern is that self-employed caregivers do not have the broader expertise needed to identify and treat complicated multisystem disorders. The clinical instruction hours of a newly graduated NP are equivalent to those of a third-year medical student. A more thorough training of a physician provides a more developed ability to solve complex diagnostic dilemmas.
Self-employed nurses have not significantly improved access to medical care for underserved citizens. Recent geographic surveys say only 5.5% practice in remote rural areas.
Unrestricted caregivers did not reduce overall costs. Studies have found that healthcare providers with less education and training are more likely to increase healthcare spending. They have a lower threshold for referring to specialists, performing more laboratory tests, ordering unnecessary diagnostic imaging, and prescribing more drugs than physicians.
The COVID-19 epidemic has highlighted how doctors in intensive care units are working alongside highly trained nurses and other experienced medical staff to manage this complicated infection. At this elevated level of care, the physician’s expertise is the driving force behind the positive outcomes achieved for these very ill patients.
Outside the hospital, in frontline medical practice, expertise and training are no less important. The increasing presence and use of less qualified non-physician independent practitioners is diluting the level of modern health care for sections of the population.
Jonathan L. Stolz, MD, is a retired physician and author of Medicine from Cave Dwellers to Millennials. He is a resident of Williamsburg.