Physicians For Patients - Public

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Physicians For Patients - Public

We educate the public about the unsupervised practice of medicine by non-physicians and oppose legis

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Physicians for Patients

According to 2015 data from the American Medical Association (AMA) and the U.S. Census Bureau, there were 9,137 older adults for every practicing Geriatrics physician and 2,852.5 people for each Family Medicine and Internal Medicine physician. Instead of increasing the number of trained physicians by increasing available residency training positions or allowing medical school graduates to practice under the supervision of a trained physician, 24 states have granted “full practice authority” to nurse practitioners (NPs). Our concerns with this:

1. Nurses granted authority to practice medicine (diagnose and treat) with less than 3% of the education and training of a physician. In these 24 states, advanced practice nurses may practice with looser practice restrictions with some needing no physician oversight at all. In many states the supervising physician need not be skilled or trained in the field the advanced nurse is practicing. Nursing is not medicine, so nurses technically cannot fill physician gaps. The American Association of Nurse Practitioners (AANP) acknowledges this difference.

2. Patients do not know the difference. The general population and legislators are not educated about the differences between the education and training of a doctor of medicine and a doctor of nursing. Many people do not know when they are seeing a physician or a non-physician. However, the majority of patients want transparency and 84% prefer a physician to have primary responsibility for diagnosis and management of their medical care.

3. Rising level of lower quality NP schools. Nurse practitioner programs are rapidly growing in number and not being reliably or uniformly accredited. Programs have varying lengths and some do not even require a degree in nursing or an RN license to enter. A growing number have 100% acceptance and graduation rates. Some are 100% online and others are hybrids of classroom and online learning. The minimum hours required for clinical work (i.e., patient contact) is 500 hours. These can be in various locations and may only be observation hours. Furthermore, the patient contact requirement is not standardized to ensure exposure to a variety of states of health or disease. Some NPs recognize and acknowledge this varying quality of NP programs and desire improvements.

4. Unsupervised NPs are not improving access to primary care. In states where nurse practitioners are granted the ability to practice without physician supervision or collaboration, so-called “full practice authority” (FPA), practice in areas already served by physicians. Yet, according to the AANP, 60% of practicing NPs work in Family primary care and 16% in Gerontology.

5. Non-physicians are adding to healthcare burdens. There is evidence that non-physicians overuse antibiotics, overuse opioids, order more radiographs, and unnecessarily refer to specialists. These not only increase the cost of medical care but can potentially lead to more superbugs resistant to antibiotics, radiation overexposure, undue stress and time spent related to inappropriate diagnoses, and burden on subspecialists who may be in short supply. In addition, the rapid growth in NP certificates contributes to the declining rate of nurses and worsens the nationwide nursing shortage.

6. Other non-physician groups will also try to practice without supervision. If physician assistants, nurse anesthetists, and nurse midwives practice without a physician’s oversight, the danger to patients will only grow.