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AMA vs. Nurse Practitioners On Scope of Practice

March 1st, 2010  |  The Blog, You're Being (Web) Paged

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.

Paul Wallis
About Paul Wallis

5 Responses to “AMA vs. Nurse Practitioners On Scope of Practice”

  • Edward Saint-Ivan said on February 14th, 2011 at 9:29 pm

    There are numerous outstanding and dedicated people in nursing but the leadership of organized nursing is vicious! The lastest outrage is forcing ARNPs to obtain doctorates because the PA-Cs won’t be able to compete and PA-C programs don’t have the resources to phase out less time consuming degrees.

  • Belgrade Glendenning said on February 14th, 2011 at 9:34 pm

    I strongly agree with the previous writer. The vast majority of nurses would give you the shirt off their back. As a whole nurses are among the most compassionate people I ever met.
    The problem is that they are represented by the most ruthless, underhanded, self serving, blood suckors in the political landscape.

  • John Smith said on February 14th, 2011 at 10:08 pm

    I hate doctors.

  • M F Anderson said on May 13th, 2011 at 2:41 pm

    Paternalism must relinquish its historical grip on the Doctor-Nurse dyad and humble itself to a respectful collegial engagement for the patients they serve to ultimately benefit from a true collaborative effort.

  • Lyn Michaels said on December 9th, 2011 at 8:38 am

    I am a national recruiter that works for hospitals across the US placing physicians and nurse practitioners, CRNAS and medical personnel in general.
    In many of the rural communities, physicians are hard to recruit. It seems they all want the larger cities or the larger practice settings with many not wanting to take call!
    That isn’t true for all settings but the vast majority of rural communities are in desperate need of experienced providers. They want providers that will stay in the community and become part of it.
    If physicians would be willing to work in these rural settings that would be great but I find more NPs that are willing to move and work in an area that has no other providers to help the community. They appreciate the type of setting it is and aren’t afraid to take call either.

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