In this age of vanishing doctors and nurses, it’s like a war of the dinosaurs about who’s going extinct first. The current moves to expand scope of practice for nurse practitioners have drawn criticism from the American Medical Association, which has in turn drawn ire from the nurses.

The AMA cites the difference between a physician’s training and nurse practitioner training as the main reason for its reservations about expanding the scope of practice of nurse practitioners.

The scope of practice for nurse practitioners is based on state legislation, and several doctor-starved states are naturally looking at nurse practitioners as logical alternatives in various areas.

The problems start here:

• In most states nurse practitioners are supposed to be under the supervision of a physician.
• In many rural areas, there are no doctors for miles in any direction.
• The general shortage of doctors is naturally aggravating this situation.

The mature, genteel, considered response has been to fight tooth and nail over various definitions of who does what.

In California, physicians are suing to ensure nurse anesthetists are under supervision of doctors. This will do wonders for the health of lawyers, journalists and others, but not a lot for healthy relationships in the profession or with patients.

With all due respect to the AMA, there are a few physical realities which are going to cause havoc if some working options aren’t created, and soon:

• The pernicious and deadly epidemic of Frayed Doctors and Nurses Syndrome isn’t showing any signs of abatement, and it’s not a seasonal disease.

• Doctors and nurses aren’t hanging around smelling the roses. They’re leaving careers after decades of expensive training and hard work.

• Retirements are going to take a huge bite out of numbers in both professions in the next five years.

• The hellish conditions in the system will get worse in direct proportion to the smaller number of people lumbered with the extra duties of care.

• The practice of producing doctors like luxury cars hasn’t exactly been plugging holes on demand. Nurse Practitioners are in the decent quality sedan class with doctoral options. Formula One training speed this is not, in either area. That’s already causing seismic events, and the tremors are ongoing.

• Projected population increases will obliterate existing capability to meet demand in a decade or so.

• Doctors may also wish to note that the joys of health funds, hospital administration and practitioner insurance have the ability to kill any level of interest in a career in medicine by anyone, doctor, nurse or wandering mortician, and that the prognosis for any improvement in any of those areas is not looking so good. It’s going to be all hands to the pump, whoever’s doing whatever.

There are no choices in this situation. The ultimate result, whatever the verbiage, will have to be “what works.” Everybody’s getting pushed over the edge somewhere, and what’s needed is a clearly understood practical working methodology so people can get on with treating patients. Guessing who’s supposed to be doing what will kill as many patients as any other indecision. It may even be as dangerous to human health as the billing process.