On Tuesday, members of the North Carolina General Assembly’s Joint Legislative Oversight Committee on Health and Human Services (JLOC-HHS) heard testimony from Christopher Conover, PhD recommending the relaxation of supervision requirements for all Advanced Practice Registered Nurses (APRNs) in NC. This recommendation was based on a meta-analysis study paid for by the North Carolina Nurses Association (NCNA). The study, which was premised on the expectation of a physician shortage, speculated that APRNs are the solution to the impending physician shortage. The conclusion asserted that relaxing supervision would have a three-fold benefit of (1) improving access, (2) improving quality and (3) lowering cost.
Many of the committee members questioned the assumptions inherent in Conover’s presentation, citing the absence of any physicians on the steering committee charged with studying a physician shortage; no grasp of the cost components embedded in the studies that were used in the meta-analysis; and the lack of comparative quality data in light of the broad spectrum of practitioners considered APRNs. Both House and Senate committee members suggested that the essence of the problem facing our state is the growing concentration of health care providers in the 14 most populous counties and therefore dwindling access to providers in North Carolina’s rural communities. The committee recommended further discussion at the next meeting in March.
North Carolina Medical Society (NCMS) staff will continue to follow this issue closely and provide you with opportunities to communicate with your legislators about the resources needed to provide care to North Carolina’s rural citizens. A copy of the slides used during the presentation can be found here.
at 10:46 am
2 quick points. First while this will improve access I haven’t seen any studies yet telling us the degree or even if we have a physician shortage in NC. Next, there are no indications that this will improve quality. That statement is ludicrous with no backing that quality of care provided by a RN is better than that of an experienced MD. Lastly there are plenty of studies that show that costs of care provided by PA’s and RN’s skyrocket and that there is no cost savings, in fact it is just the opposite.
at 9:16 am
This latest move for autonomy of advanced practice paraprofessionals indicates the phsyciian community needs to stop, take a deep breath and join forces to re-define what a phsycian is and what a physican does for society. Grumbling about further erosion of physician authority or prestige does no good and actually helps the advanced practitioners gain the moral high ground. We MDs and DOs need to be more proactive and forward thinking in the 21st century and we need alliances with the more influential stakeholders- hospital associations, private and government payers and consumer groups.
at 1:15 am
I agree. This is especially true of PAs who consider themselves “Mavericks” in decision making and best practice in providing outcome based health care! It’s what they don’t know that they think they know that will get them and their patients in trouble! Patients deserve our best educated effort and that means close supervision in humble recognition that shared knowledge and experience trump reckless enthusiasm and speed in decision making for best outcomes!
at 11:56 pm
All-in-all, I don’t think it will be cheaper to dispense with physician input as I have found that with more experience and training, a provider needs LESS expensive tests and work-ups for the job at hand. Perhaps the best model of how the physician-FNP should interact is the current anesthsiologist-nurse anesthetist model. For best outcomes in general anesthesia,I believe that the anesthesiologist needs to do the very important initial evaluation of each patient marked for general anesthesia, keeping in mind medications,concurrent disease problems, medical history, etc. and then be available for unexpected problems, then for most routine cases the nurse anesthetist can thereafter handle the case alone.
at 6:46 pm
Wisdom is better than knowledge….comes to mind
If we want to solve the healthcare manpower shortage, perhaps the solution that could be implemented immediately would be a release from the mountain of paperwork and administrative problems forced on us by the NC General Assembly. The prior approvals for 30 year old generic medicines and imaging without any demonstrated benefit come to mind. Rural area physicians are buried by increasing costs and lower reimbursements from medicaid cuts for primary care physicians. Is it any wonder that younger physicians saddled with debt as well as extenders saddled with debt chose to go where salaries are higher? Fee schedules for primary care are higher in urban areas than rural ones and small practice physicians are discriminated against in fee schedules as well.
There are many solvable problems in healthcare but lessening supervision requirements isn’t the way to fix any of them. Perhaps, a link to the study and its assumptions could be posted as well.
at 5:48 pm
The road to Hell is paved with good intentions! As good as Chris Conover may be, the wisdom of the committee was as obvious as was the absence of physician input and supporting data in this presentation. Having helped write the guidelines for PAs with Drs. Harvey Estes and Eugene Stead for the NC Board of Medical Examiners, and having had the first PA in a private practice setting, it is still quite clear that an experienced and wise physician must be close by as a consultant to these young physician extenders. Age and wisdom trump youth and enthusiasm every time and protect the innocent and naive public from misplaced abuse.