Nurse Practitioner Or Doctor - Does It Make A Difference?

The scope of practice and the amount of autonomy for nurse practitioners varies from state to state. In Pennsylvania, nurse practitioners are currently required to establish a collaborative agreement with a physician in order to practice. The same is true in New York. However, in New Jersey and 30 other states, nurse practitioners can independently diagnose and treat patients without physician involvement.

There is currently legislation pending in Pennsylvania that would allow certified registered nurse practitioners to practice without a collaborating physician. The Pennsylvania Medical Society is opposed to this. The medical society posits that requiring a collaborative agreement with physician is a necessary patient safeguard. It ensures that a patient will have direct access to a physician when their care requires a more highly trained professional. Moreover the PA medical society maintains that this would effectively eliminate the valued team based approached to medical care and ultimately jeopardize patient safety.

As a physician, I support certified registered nurse practitioners having the option to diagnose and to treat patients independent of a collaborative agreement with a physician. With millions more people now insured as a result of the Affordable Care Act particularly in physician shortage areas, having health providers who can function independently is beneficial. If clinical practice continues to evolve into requiring health providers to follow predetermined health care algorithms, there should be minimal additional risk to patients.

I feel strongly that patients need to know the level of training of their health provider. Additionally, patients need to have the ability to choose whether they want to be seen by a physician or a mid-level provider.

Lastly, certified registered nurse practitioners do not complete 4-6 year residency programs in their specialty. If with less clinical training, a CRNP chooses to work independently their responsibility and liability should be reflective of their independent practitioner status.

If you feel strongly about the type of care you receive, let your state legislature know.

Sharan Abdul-Rahman, MD

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