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
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
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