Nurse practitioners make their case

[flashl]

Nurse practitioner Ruby Houck opened her medical clinic in Bertrand in 2000 knowing she would have to — according to law — find a doctor to be her collaborating physician.

“I asked every physician to that lived in my county — eight different people — but no one would agree to sign on,” she told the Legislature’s Health and Human Services Committee on Thursday. “The doctors did not see a need for another health care facility in the county.”

Finally, another doctor agreed to collaborate with her, and her practice grew by the week, she said. But in 2004, the doctor sent a letter saying he no longer wanted to collaborate, and she was left again to search. She contacted nine clinics with multiple physicians and five other individual doctors who all declined because of no interest, being too busy or having employer restrictions against collaboration.

...

Houck and several other nurse practitioners told the committee about the problems they have had in finding collaborating doctors, or having doctors charge them thousands of dollars to sign a collaboration agreement.

They asked the committee to move to the Legislature LB753, a bill that would allow nurse practitioners to practice without an agreement with a physician after five years, if the person’s record were free of disciplinary action.

Nebraska Journal Star

What do you think?

[ironrooster]

1. excellent idea as long as they

stay within the bounds of their practice. I would have no qualms going to a nurse parctitioner for ordinary office visits and checkups. this would presumably reduce the cost of routine care and lessen the numbers of persons going to ER's for primary care.

[jody]

2. Makes sense to me as long as there are limitations on the type of medical procedures authorized, i.e

nurse practitioners should not be a full substitute for a Doctor of internal medicine.

[Warpy]

3. Fabulous idea!

MDs have 8 years of education: 4 years premed and 4 years of medical school. NPs have 6 years of education: 2 years of prerequisite courses and 4 or more years of intensive medical courses. Contrast that with the PA who can have 4 years of basket weaving followed by 2 years of medical education. Most of them have no problem finding doctors to cosign a practice because of that "Physician's" in the title. Doctors seem to feel it's a comedown in the world to provide backup to a lowly nurse.

I agree with the above change. It rewards well trained and competent professionals with the autonomy they deserve while releasing them from that "handmaiden" stigma. It's about bloody time.

I worked with both PAs and NPs. The only PAs who were worth anything at all started out as RNs. Otherwise, we were always calling the physician on call to verify orders that made no sense or would have killed the patient.

There is a huge salary difference and it favors the PA. Caveat emptor.

[Heddi]

4. In WA State, NP's do not have to have a MD Collaborator

They can (and do) work independently in offices and clinics. This is a recent change, too, as NP's were allowed to have prescriptive authority but had to have an MD sign any Rx's for Schedule drugs/Narcotics.

The NP's brought up a fight for the same reason, and they won. NP's now practice independently in WA state and are allowed to write Rx's for Schedule/Narcotics without MD oversight. They can perform simple surgeries (suturing a cut hand and things like that). They have very broad powers and many MD's were quite upset about the changes---felt the NP's were hedging in on their territory.

Other MD's, like the cardiology clinic MD's I work with loved it. They have several NP's in their practice who work alongside the MD's but have much more direct patient care than the PA's-----when I get an order from a PA,I think "MD's little slave" because our hospital has a policy (and it may be state rules, too) that within X amount of time of a PA giving an order, an MD must sign it,and certain orders cannot be fulfilled unless the MD signs after the PA. PA's are never on call, etc.

NP's, on the other hand, do not need co-signature for orders to be implemented and frequently take call as the "first line of defense" for the MD's that they work with.

[Celebration]

5. Interesting

It just totally makes sense to me to have paraprofessionals in this field. I really hate to say it but Walmart getting into this makes sense. At least they can't outsource their nurse practitioners to China.

Washington State is really progressive--Bastyr University is an excellent school, and they led the fight to have NDs be licensed, and NDs are required to be covered by health insurance plans. My daughter goes to one, and she is very happy to go to an ND as her primary care physician. She can go to an MD specialist if needed. Acupuncture is also covered by her health care plan.

[philb]

6. We go to Nurse Practitioner Clinic for most common things, they refer to MD

for complicated things when needed.
This clinic hired the test director for an HMO and their tests are more up to date and advanced than my GP.
We've had good experience with them, some non-prescription treatments available there not available at my GP. They also have cold laser for inflammatory conditions and soft-shell HBOT which my GP doesn't have. But they are under an MD.
I know they have changed MDs at least once. They were under a Geriatrics MD but now a GP.

[WeCanWorkItOut]

7. Excellent idea. I particularly appreciate the way NPs seem to be good listeners.

Also I've twice had the experience of the NP making the right diagnosis,
after the MD was baffled or mistaken. So it would be wonderful if
more people had the option of consulting an NP.