Pennsylvania Nurse Practitioners are scheduled to visit the state capital en mass, on Tuesday, April 29, 2014 to speak to elected representatives about expanding primary care in Pennsylvania.
There is a critical shortage of primary care physicians in
our country, and this is having a disturbing effect on seniors in Pennsylvania.
AARP,
Forbes, and other commentators mentioned later in this
article have proposed that the void be filled by Nurse Practitioners and
Physician Assistants. One study by the Institute of Medicine and the National
Research Council reports
that, when compared to 16 other high income countries, Americans not only
die younger but have poorer overall health.They traced that disparity to a
number of causes, including the fact that Americans have "more limited
access to primary care."
As more citizens receive medical benefits because of the
Affordable Care Act, and as the number of seniors continues to increase up to
the year 2047, one might expect the problem to go from bad to worse. An article
in the Spring, 2013 Journal of the National Academy of Elder Law Attorney
suggested medical care in the future will become so scarce, that the success of
the Elder Law office a few years from now will depend on the ability to connect
clients with health care.
Pennsylvania Senate bill 1063 of 2013 would allow nurse
practitioners to operate independently, thereby easing the shortage.This is
not too dramatic a change from today’s situation. An increasing number of
people visit a CVS Care Center or a
Minute Clinic or Now Clinic for help with a health problem. In that setting,
you are seen by a nurse practitioner. Although, in Pennsylvania, the nurse
practitioner is supposed to be working in collaboration with an M.D., you will
never see, nor speak with, an M.D. during your visit. The collaboration is a mere formality. The
same events are taking place where large corporations are hiring a nurse
practitioner to staff a clinic at the place of employment. While a very good
idea, the only problem with this approach is that the company must be able to
pay both the nurse practitioner and the physician.
The purpose of the new legislation is to avoid the need for a physician to get
involved. As you might expect, the American Medical Association is opposed
to giving patients the choice to decide for themselves, stating the additional
experience of an M.D. is required. One group, the national Institute of
Medicine, an independent panel that advises the federal government, hit the
nail on the head when they
said that many states' regulations
on nurse practitioners were "overly restrictive" and based on
politics. The Federal Trade Commission issued a report that was in agreement
with most everyone else, that restricting the practice of Nurse Practitioners
is bad for the public. It would seem that most of us are capable of
deciding whether we want to visit a nearby hospital emergency room or a nearby
“Minute Clinic” or other health care clinic staffed by a nurse practitioner. You still have a choice who to visit.
If the law is passed, then Pennsylvania would join the 16
other states and the District of Columbia that allow NPs to practice "completely
independently of a doctor and to the full extent of their training -- i.e.,
diagnosing, treating and referring patients as well as prescribing
medications." Alaska, New
Hampshire, Oregon and Washington were the first states to adopt broader
licensing authority in the 1980’s to increase the supply of primary care
providers. Other states followed in the 1990’s, so there is plenty of evidence
about the efficacy of the idea. The states that allow the expanded use of Nurse
Practitioners do not experience any worse outcomes than the states with the
restrictions.
Even though some
elected officials in Harrisburg side with the A.M.A., guess what? Our elected officials use the clinic in at the
Capitol manned by a Nurse Practitioner, without a physician in site, and it does not seem to bother them. It
seems silly for them to say it’s okay for them, but not for us.
Some publications, like this report from
The Health Economist, published at the University of Pennsylvania, feel the
change is inevitable and the delay is only to protect turf and money.
The stance of the A.M.A. seems silly in light of the fact that the nurse practitioner will refer to M.D.'s who specialize in a particular field. As the spouse of a nurse practitioner, I can say that one of the countless benefits I receive is that she finds an appropriate specialist for my needs, and that has been an enormous benefit to my health. Like most people, would have no idea where to start on my own, nor what specialist to see.
I strongly suggest you call your elected representative and
ask them how they feel. If they feel okay, it may be because they have access
to the primary medical care their constituents want too. Let them know you want
to have the choice of deciding whether or not you want to see a nurse
practitioner rather than wait several weeks, or visit a hospital emergency room, for
primary care.
In honesty, some of our local officials in Philadelphia and
surrounding counties are either co-sponsors or supporters of the bill. However,
even those who support the bill have told me they would love to hear from their
constituents rather than just hear from the lobbyists on either side of the issue.
Stay well until the next post. Let me know about ideas you would like to read about in my blog.
Robert.Gasparro@lifespanlegal.com
Visit our website at www.lifespanlegal for more information.
