Nurse Practitioners Push for More Freedom Back Bill Allowing Them to Forgo Supervising Doctor

Article excerpt

From sick babies to diabetic seniors, Mona Counts has treated thousands of patients, many of whom would travel an hour or more to visit her primary care health clinic in rural Greene County. She knows their family medical histories better than they do because she treated their parents and grandparents over the decades.

"Patients would describe me as an old-time family doc," she said last week.

But she's not a family doctor -- she's a nurse practitioner, and doesn't have an M.D. behind her name (though she does have a Ph.D.). So, despite her wealth of experience, state law says she's not allowed to operate a full medical practice without collaborating with two supervising physicians.

It's a requirement whose utility has come and gone, says Ms. Counts, now in her 70s and semi-retired. Back when nurse practitioners "were relatively new on the marketplace, [doctors] wanted to make sure they would be safe providers of health care," Ms. Counts said. But "the need for that collaborative agreement has just gone away."

That's why Pennsylvania's nurse practitioners are pushing for a change in state law, contained in Senate Bill 1063, that would allow them to practice as independent primary care providers without first signing collaborating agreements with supervising physicians. Eighteen other states, and Washington, D.C., have done the same, giving nurse practitioners "full practice authority."

Nurse practitioners who work in the primary care realm, which is most of them, are able to do many of the things that primary care doctors do -- evaluate patients, order and evaluate diagnostics tests, prescribe drugs, refer to specialists.

Allowing them to function independently could help relieve the oncoming shortage of primary care physicians, said Lorraine Reiser, a director with the American Association of Nurse Practitioners, and a nursing professor at Clarion University.

"When my previous collaborating physician left, I was forced to find another," said Ms. Reiser, who practices at the Hilltop Community Healthcare center in Pittsburgh's Beltzhoover neighborhood.

In Pennsylvania, a nurse practitioner who wants to prescribe drugs to patients must have partnerships in place with a primary physician collaborator, as well as a backup. If those partnerships aren't on file and renewed every two years, a nurse practitioner can't prescribe and, essentially, can't practice.

It may sounds like a mere administrative hurdle, but at times, the requirement acts as a barrier to care, said Kathy Magdic, an acute care cardiology nurse practitioner who practices at UPMC Presbyterian. If a practitioner is operating a clinic in a rural area where there aren't many primary care physicians nearby, it can be difficult to find new doctor collaborators.

If that happens, a nurse practitioner can be "forced to shut down her practice," Ms. Magdic said.

Physicians are also limited as to the number of collaborating agreements they can sign (a maximum of four), and in cases where a physician works for a large medical center, sometimes the center won't permit the doctor to sign a collaborating agreement with nurse practitioners who work outside the hospital network.

And some physicians charge nurse practitioners and their clinics for their collaboration services, adding to overhead expense.

Changing the law in Pennsylvania could take some time, though, if history is an indicator. Pennsylvania was one of the last states to allow nurse practitioners to prescribe drugs. That happened in 2000, and the campaign to give them that authority took more than a decade. …