Hazardous to our health?

With more than 30 years of experience in family medicine under my belt – I started my career as a physician assistant before becoming a practicing physician – my training as a physician was living proof of the old adage, “you don’t know what you don’t know.” Before I completed my physician training, I knew my training as a physician assistant had its limits, but I was not fully aware of just how much.

There is no doubt that I learned a lot in my schooling and on the job as a physician assistant, but what I learned in preparation to become a physician assistant simply did not and could not compare to my osteopathic physician training. My osteopathic physician training was more rigorous and consisted of considerably more hands-on training than my physician’s assistant training ever had.

Unfortunately, lawmakers in Harrisburg are considering legislation (Senate Bill 25) that would provide a shortcut for thousands of Certified Registered Nurse Practitioners (CRNPs), also known as nurse practitioners, but without the education or training required of one. Currently, these professionals are required to work collaboratively with a supervising physician. They are valuable members of our medical practice – but they are not physicians.

Obviously, this could have significant implications for patient safety.

Currently, nurse practitioners work under supervision of a physician as part of a patient care team through a collaborative practice agreement. This bill would eliminate the collaborative practice agreement once a CRNP reaches just three years of such physician supervision.

Under this bill, CRNPs would have the authority to independently prescribe drugs, including controlled substances, and take other actions normally handled by a skilled physician, without any oversight or guidance. In addition, CRNPs would act as primary care providers under state health insurance plans.

Nurse practitioners receive 750 hours of lecture and practice or learning hours, compared to more than 12,000 hours of supervised postgraduate medical education residency training and hands-on practice and 8,000 hours of basic medical science education in medical school. That gap cannot be closed by passing a new state law.

Lawmakers and members of the public also need to understand the potential impact this legislation could have on the state’s opioid epidemic. The bill would grant CRNPs greater authority to prescribe drugs, including controlled substances, without the needed direction and guidance from a physician. As Pennsylvania and the entire country are looking to place greater controls on the prescribing of opioids, this bill would loosen protections.

Proponents of this bill have claimed that these measures will allow and attract more CRNPs to the rural areas of the state. These arguments simply don’t pan out. The state of Arizona has permitted independent practice for CRNPs for several years, but the migration data demonstrates CRNPs have not migrated to the state’s rural areas.

CRNPs practice in the same areas of Pennsylvania as that of physicians. While there is no doubt CRNPs are a critical part of the healthcare team and help provide additional access to care, granting them independent practice via legislation will not solve access to rural healthcare access. There are other ways, like telemedicine, that can be much more effective in providing access to healthcare in rural areas.

The partnership between an osteopathic physician and the professionals they work with are invaluable to the doctor, the professionals and the patients they serve. Physician oversight is key to preventing medical errors and giving the patient a medical team that works collaboratively to provide the best possible healthcare.

There is no substitute for the rigorous education and training I received to become an osteopathic physician. To essentially turn over the role of physicians to CRNPs and physician assistants when no benefits to patients have been shown may very well prove to be hazardous to the health of all Pennsylvanians.

Dr. Joan Grzybowski is president of the Pennsylvania Osteopathic Medical Association, which represents more than 8,000 osteopathic physicians in Pennsylvania.


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