NY docs, nurses debate scope of practice

Doctors and nurses continue to debate a New York bill that eliminates the need for experienced nurse practitioners (NPs) to have written agreements with doctors in order to see patients, the Post-Standard reported

The physician shortage is a problem in the state, like many others around the country, and NPs can fill the gap as they diagnose and treat illness and prescribe drugs just like doctors do.

But NPs argue that the written agreement requirement is outdated, burdensome and can jeopardize an NPs practice if one of the physicians with whom they have a written agreement leaves, according to the article.

Although some doctors support NPs' independence, Andrew Merritt, M.D., a family physician who practices in New York, disagreed with the practice. "They function best as part of a team approach to patient care and the team should be headed by physicians," he told the publication.

In response to the article, Philip Kaplan, M.D., former president of the New York State Academy of Family Physicians, wrote an opinion piece in the Post-Standard, arguing that doctors and nurses should work together to ensure patients get the best care possible. 

However, he said abolishing the written agreement would disrupt successful team-based care models.

"Physicians value the wisdom and dedication of nurse practitioners. Optimal solutions for the primary care shortage should arise from the mutually respectful collaboration of nurses and physicians," Kaplan wrote.

As healthcare shifts away from fee-for-service and smaller independent practices to team-based care at large health systems, Kaplan said the team approach under physician supervision can improve patient outcomes and reduce costs through mechanisms like patient-centered medical homes. Physicians must view NPs as an essential part of the healthcare team, working together to assist patients with treatments, tests and specialty care, while helping them navigate a complex health system, he said.

This isn't the first debate between doctors and NPs regarding scope of practice. Doctors voiced concerns after the Veterans Health Administration proposed nurses with advanced training practice medicine without physician supervision, FierceHealthcare previously reported.

To learn more:
- here's the Post-Standard article
- read Kaplan's opinion piece