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Front Page » Healthcare » Doctors fight expanding non-MD roles

Doctors fight expanding non-MD roles

Written by on March 26, 2014
Doctors fight expanding non-MD roles

Doctors, nurses and physician assistants often work together, yet they’re not always on the same team when it comes to legislation.

That’s currently the case with bills before the Florida Legislature that would give nurses greater powers and give physician assistants greater numbers.

Separate proposals would double the number of physician assistants who can work under a single doctor; would allow nurse practitioners to have their own practices; and would allow nurse practitioners to prescribe controlled substances.

The Florida Medical Association, or FMA, which represents some 20,000 physicians, is opposing all three measures – although it seems willing to compromise on the physician assistant issue.

Willa Fuller, executive director of the Florida Nurses Association, said the medical association apparently doesn’t want nurses infringing on the professional turf of Florida doctors.

“In my personal opinion,” she said, the opposition “may have something to do with status.”

FMA spokeswoman Erin VanSickle said the association has “historically” opposed allowing nurse practitioners to run practices independent of physicians and allowing them to prescribe “narcotics.”

“The FMA opposes nurses’ efforts to practice independently and prescribe narcotics because it is dangerous for patients,” FMA General Counsel Jeff Scott said in a statement. “There is no evidence that such broad-based expansion will reduce costs to the healthcare system.

“While the FMA values physician extenders and the important role they play in the healthcare team,” Mr. Scott added, “allowing them to practice independently and prescribe narcotics is unnecessary and unsafe.”

On the issue of allowing nurse practitioners to run independent practices, Florida Nurses Association lobbyist Alisa Lapolt said: “I think it [the opposition] comes down to money, quite frankly. There are 19 million people in Florida and, for some reason, physicians think they should corner the market.”

On the bill to allow nurse practitioners to prescribe controlled substances such as painkillers, psychotropic drugs and testosterone, she said: “Their argument is that nurses aren’t educated enough to prescribe them.

“Our reply,” she added, “ is we are [educated enough] and prescribing medications is part of the curriculum for nurse practitioners, who can prescribe everything else, including medications that can be dangerous, like those for controlling blood pressure.”

Nurse practitioners, according to Ms. Fuller, are permitted to prescribe controlled substances in every state but Florida.

She said the nurses association is pushing the bills primarily because it would make medical care more accessible to patients. Currently, she added, nurse practitioners can open private practices in Florida but they must collaborate with or be supervised by physicians, whom nurses pay or contract for their assistance.

Also, she said, giving nurses the ability to prescribe controlled substances would help avoid delays in providing care.

Versions of both bills are still before House and Senate committees, where they would have to be approved before a vote of the full House and Senate.

Meanwhile, there hasn’t been significant opposition from the FMA on the bill to double the number of physician assistants permitted to work under a doctor in Florida from four to eight, said Dayne Alonso, legislative chair for the Florida Academy of Physician Assistants, which is supporting the bill.

However, she added, smaller groups representing physicians of certain specialties have taken positions against it.

Ms. VanSickle of the FMA explained that her group is “currently opposed to the [physician assistants] bill, but we are working with them to see if there is an acceptable solution.”

Florida Academy of Physician Assistants Executive Director Tina Kautter said the bill also is about making health care more accessible, and it may create more jobs for physician assistants as well.

Academy board member Jeff Hulley said the bill has passed a House committee and is waiting to be heard by a Senate committee.

He said physician assistants often can spend more time with patients and explain more to them because they generally have more time than physicians. As such, he added, the bill would help counter a shortage of primary care physicians.

He said physician assistants are permitted to do most things that doctors can do. One of the things physician assistants can’t do is act as a primary surgeon.

“There also are three or four other things they only can do under the direct supervision of a doctor,” he added. “Doctors can delegate almost anything in their practice [to a physician assistant] that they feel comfortable with.”

However, the FMA has reservations about the bill.

“We know that the projected shortage of doctors and nurses is a very real concern to every Floridian,” Mr. Scott said, “and we will continue our work to expand patients’ access to care in a way that is safe and affordable for patients.”


4 Responses to Doctors fight expanding non-MD roles

  1. Laurie Grissman

    March 27, 2014 at 10:03 am

    This is exhausting listening to the pathetic arguments of the FMA… The FMA is the only group against the bill to allow ARNPs to prescribe. The FMA has absolutely no evidence the ARNPs don’t prescribe safely. There is no difference between nurse practitioners in 49 other states who prescribe controlled substances and nurse practitioners in Florida.
    I have had over 2000 controlled substances prescribed by 7 nurse practitioners in my company that waited weeks to get “signatures” from the doctor… The doctors who collaborate in my company get paid $60k a year and have never seen one patient in my practice that they have written rx for…

    So you tell me….. Are they against this bill because ARNPs are unsafe or because physicians will lose money!

    And in primary care…’s time for the board of medicine to change the primary care curriculum!!!!! If ARNPs have evidence that our outcome in primary care is the same or better than physicians then we have demonstrated that it isn’t necessary to go to school for 12 years to practice primary care…..

    And I guaranteed the information that a primary care dr learned in school 15 years ago is useless with today’s ever changing research and technology….. You have to educate yourself everyday in this business not just 12 years in school!!!!

    It’s all POLITICS!!!!


    April 8, 2014 at 12:20 am

    Unfortunately it is true for the other professions as well.It is about protecting the pockets of the vested interests.In Florida,if you are a graduate of foreign country’s Dental school-you will never be allowed to practice.And if you are a graduate of a Dental school from another state-the same holds true.You will be required to complete your dental degree all over again at a Florida university.If you want to practice here.Just about each year the Florida legislature considers barring or making it difficult to practice some professions or trades because these professional associations or trade associations lobby the legislature to make laws to keep others out or from expanding their duties.And of course it is all in the name of patient safety or keeping out incompetent trades persons etc.If you graduate from a dental lab school as a dental lab technician-you will not be able to open your own lab unless you join a certain association here in Florida that was responsible for that piece of legislation.And of course-this organization sets out the requirements as to when you can open your own lab.Interestingly,the sponsor of this legislation was supposed to be a consumer advocate.And to a certain extent he was.This legislator is no longer in the Florida legislature as he was defeated.It is like we have returned to the guilded age.

  3. Dr. D

    April 12, 2014 at 3:11 pm

    I’m all for these nurses expanding their practice. Let them undergo additional years of training, like residency or years of fellowship, and pay the same as physicians do for malpractice coverage.

    The argument that nurses make less mistakes with controlled substances, or that doctors make more mistakes is ridiculous since all the scripts these nurses are currently writing had to be cosigned by a physician. And it is the physician who is held responsible when there is a mistake, or medical error, not the nurse who originally wrote the script or made the medical error.

    Just because other states are doing it doesn’t make it sound guidance. As previous comments delineate economics play a large role. And nurses, who do not spend years of their life in residency, accumulate hundreds of thousands of dollars in student loan debt, or pay thousands of dollars per year for malpractice protection (even if never having been involved in a suit), clearly do not get it – or are instead trying a back door approach to reap the benefits without all the hard work and commitment doctors have undergone to become what we are – a fully licensed physician with complete practice rights that extend beyond those of health care “extenders”. This is a benefit we experience for years of additional training, extra expense and sacrifice.

    So I say let the nurses have this right, allow them better access to medical school, residency programs, and let them become doctors.

  4. Jennifer

    April 17, 2014 at 7:35 pm

    Dr. D:
    It is that very ignorant attitude that pushes patients to seek the care from a more compassionate and knowledgeable source like an NP. I have spent my life in “residency” of 12 hour shifts making pennies caring for critically ill patients and their families, as you breeze through and duck to avoid talking to anyone. I can assure you my student loans are in the six figures and I don’t receive the pay in return. You know nothing of what nurses do and learn. it is appallingly clear from your message. Your message seems like you believe yourself to be very knowledgeable and hard working. if you practice in a hospital, I encourage you to sit and watch, more than a few hours, how much nurses do the entire 12 hour shift (and that is just the first 12 hours of their day. We learn from our patients, families, each other, school, mentors, just name a few….