Nurse Practitioners are Valued Members of the Care Team

The following is a guest opinion written by Bruce A. MacLeod, MD, president of the Pennsylvania Medical Society, in response to the article “Nurse practitioners:  unshackle us from doctors.” Dr. MacLeod is a practicing emergency medicine physician from Pittsburgh.

“Nurse practitioners: unshackle us from doctors” (April 29) gives the warped impression that our nurse practitioner colleagues somehow need to be “freed.” Nurse practitioners are essential and valued members of patient-centered, physician-lead medical teams who contribute a great deal to the well-being of patients.

Suggesting that nurse practitioners need to be “unshackled” disparages the current collaborative agreements that are functioning well across our state and devalues our nurse practitioner colleagues who add a great deal to the health and well-being of the Commonwealth and have chosen nursing as their vocation.

Currently, Pennsylvania law requires nurse practitioners to practice with a collaborative agreement with a physician. These collaborative agreements describe how both a physician and a nurse practitioner work together to assure the best care is provided to a patient. At the moment, some nurse practitioners are lobbying the state legislature to practice without these collaborative agreements and Senate Bill 1603 would remove this requirement to collaborate.

This is a step in the wrong direction: the practice of modern medicine requires a team-based approach where care is coordinated and all health care providers practice to the full extent of their training and experience. A physician typically has between 12,000 and 16,000 hours of total patient care through medical training.  A nurse practitioner has 500 to 720 hours. That’s a big difference.

One former nurse, now a medical student, stated “when you train to be a nurse they train you in ‘how.’ When you train to be a physician, you are trained in ‘why.” Effective patient care requires understanding both how and why specific kinds of medical care are provided.  Collaboration assures this approach.

The looming “primary care shortage” may not in fact exist, at least not to the extent predicted. A recent study by the University of Pennsylvania suggests newly insured patients are able to find primary care services from a physician. Nurses will not expand access to primary care as studies have shown that nurse practitioners are not more likely to move to a medically underserved area.

The “shortage” and “lack of access” may actually be a geographic problem. That is, we have an adequate supply of primary care providers in Pennsylvania but their distribution across the state is the issue.  Encouraging more physicians and other health care providers to practice in health professional shortage areas with incentives like student loan forgiveness for primary care will solve that issue, not giving nurse practitioners independent practice.

Having worked with nurse practitioners, I can say that physicians are not looking over their shoulders with every patient interaction.  Rather, we rely a great deal of the keen observations and technical skill of our nurse practitioner teammates. Today in Pennsylvania, nurse practitioners have no barriers to practice to the full extent of their training. Simply put, there are no shackles.