[Regarding “Minnesota Becomes 19th State to Allow Nurse Practitioners Full Scope of Authority to Prescribe,” published online Dec. 17, 2014,] physicians need to wake up and begin to lobby against the repeated intrusions into our scope of practice. There is a reason nurse practitioners (NPs) and physician assistants (PAs) are mid-level providers—they lack the education and training of physicians! Does it make sense to anyone that clinicians with less education and training should have the same prescribing authority as physicians?
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ACEP Now: Vol 34 – No 03 – March 2015I started my health care career as a paramedic, then went on to nursing, and now it seems as an emergency physician I could have just bided my time, and eventually at this pace NPs will have the same authority I do. I’ve already seen them introduce themselves as doctors now that many NP programs have gone to doctorate-level degrees.
Many states, including Alabama where I practice, have allowed NPs to place CVLs [central venous lines] and art-lines. I’m very opposed to this and have written to the medical board speaking out against it. Physician leaders are asleep at the wheel on this topic.
It reminds me of how physicians allowed themselves to become just another “cog” in the health care wheel in the early ’80s. Physicians were at the top of the health care corporate structure, often then president or chairman of the hospital, then one day we decided that management should be turned over to HCAs. Now look where we are, hoping our reimbursements aren’t reduced or tied to performance, accepting policies governing our practice instead of dictating them.
This is another issue where mid-levels will continue to take more and more rope. Wake up!
—Michael Menowsky, MD, RN, BSN Birmingham, Alabama
34 Responses to “Opinion: Nurse Practitioners, Physician Assistants Should Not Have Same Drug Prescribing Authority as Physicians”
March 22, 2015
Gregory RainesDr. Menowsky,
Your “letter to the editor”/opinion piece is no more than a call to arms to attempt to disarm a group of health care professionals who too have spent many years training and working in medicine, usually in partnership with physicians, providing access to people where physicians won’t go. Your solution is to attempt to roll back the clock and make access for them more difficult? How exactly does that benefit patients? It doesn’t.
Do you have any data showing advanced practice providers (mid-level providers is a DEA designation for non-physican providers, not an official designation assigned to PAs or NPs) are inappropriately misprescribing medications? Do you have any data at all showing worsening abuse potential by PAs and NPs when prescribing medications? We can look at the disciplinary complaints of various medical boards and compare apples to apples – when you do, you’ll find its physicians who abuse their prescription rights moreso than PAS and NPs.
Do you have any data showing that PAs and NPs have higher complication rates associated with placements of central lines, intubating patients, placing arterial lines, or doing other advanced procedures? You don’t. The only literature that is available looks at ICU use of PAs and comparative outcomes of PA-run ICUs (under physician supervision of course) vs. traditional ICUs. You won’t like the data – the PA ICUs have better outcome rates.
So at a time when there aren’t enough health care providers, PAs already prescribing in all 50 states (some have schedule limitations – again, no data to support this nonsensical handcuffing of providers), and NPs are trying to attain prescribing rights so they too can care for patients to their fullest capability, what is it exactly that you are protesting? And why? You want to stay at the top of the medical food chain – that’s the only thing I glean from your article.
This retrograde approach to the practice of medicine had no basis in fact, is nothing more than a call to arms to “protect turf” against other providers, and smacks of elitism. Even as an opinion piece, I am surprised this was allowed to be published in ACEP Now as EM PAs have been nothing but supportive of our physician colleagues and supportive of ACEP itself. Be careful in how you choose to lump PAs and NPs together – PAs have always supported the team approach to care, with physicians as the lead provider, but if you are going to pick a fight with other providers, perhaps PAs themselves would be better off aligning with NPs or declaring themselves independent providers and push for changes in legislation to that end.
As this is in response to an “opinion” piece, I will state that this is just my “opinion” as well. But be careful in how you catalog PAs – we support the Physician-led team approach. We do not support inhibition to access to care.
Sincerely,
Gregory Raines, PA-C
Immediate Past President
Society of Emergency Medicine Physician Assistsnts
April 27, 2015
robertAt our facility we employ NP and PA staff to be engaged in the higher acuity and complex/critical care management patients. With such knowledge we are able to work more effectively as a team. Every PA/NP has gone through central line training and we encourage our staff to perform the procedure when indicated. Over the years our “MLP” staff have gained this skill set to be quite robust to the point of being educators for all of our group with respect to procedure lab including providing instruction to our physicians who from time to time need refresher courses depending on the number of lines obtained etc.
Most importantly is that our team has developed this practice together and escalates the entire team in education.
The consensus is that the opportunity to being the most educated as you can be in a discipline is not a hinderance but a value to our customer. We are brothers in arms on this point. In the end it is not about the practitioner but the client and any tool we can use to provide a better service with quality work is key. We wouldn’t want it any other way.
Robert Fields,DO
Chairman of the Department of Emergency Medicine
Saint Joseph Mercy Livingston Hospital
Saint Joseph Mercy Brighton
May 10, 2015
Dan Campbell, PA-CFirst, I will have to agree with Greg Raines, Dr. Fields and several others that mid-levels are a benefit to patient care in many ways & not just with prescribing authority……
Dr. Menowsky should wake up, open up his eyes, and get with today’s program. Times and medicine have changed and mid-levels are here to stay. Perhaps he should try to join forces rather than be negative and fight them.
I do not have data in hand, but if he would take time to research Board statistics, he probably would find there has been more physicians with medication errors AND substance abuse than mid-levels due to “their” prescribing authority.
Most MLP’s today are quite educated through all the new and updated professional standards required by our State Boards. We may not have extra years of education as
physicians, but we all have to be approved by physicians, State Boards, And the DEA in order to practice with or without prescribing privileges.
So rather than be angry about it, take time to appreciate us, and be glad we can help you financially and save you a lot of time providing much of the same kind of care for patients as he perhaps does. Thanks! Dan
March 22, 2015
MarkWow. Do I detect an angry tone here or what?
I am a Physician Assistant, former Paramedic, and have been working in EM for almost a decade.
I am not a physician. Don’t want to be one. Don’t think that there is any need for Np that has a doctorate level to introduce themselves as a “doctor” as it will only confuse the patient. But that is their title, no different than a psychologist.
As a PA, I have placed central lines, performed endotracheal intubations, run traumas, run codes, placed pacemakers, and performed LPs as well. Should I not be allowed to do any of these because I am not an almighty physician and cannot walk on water?
We are well-educated, driven providers. The extreme vast majority of us do not pretend to play doctor. We work WITH physicians, not AS physicians.
Why should we not be allowed to prescribe? Why should we not be allowed to perform procedures if we are appropriately educated and trained?
Your letter smacks of arrogance and territoriality. You state that you were a Paramedic. Perhaps you recall that in the 1970s a lot of physicians did not want Paramedics to exist at all. Your attitude comes off with this same level or arrogance, condescension, and holier than thou attitude.
Instead of having a temper tantrum via your keyboard, you might want to back up your feelings and beliefs with a bit of research or data instead of emotions.
Just a thought.
January 13, 2019
David Lyon, PA, MDMark, I like your response.
Thank you.
March 22, 2015
David PecoraI would like to comment about the opinion piece by Michael Menowsky, MD. The title of his piece is: “Nurse Practitioners, Physician Assistants should not have same drug prescribing authority as physicians”.
I am a physician assistant in Minnesota. A physician assistant licensed in Minnesota is allowed to write for and prescribe DEA Schedule II – IV medications. OR as allowed/permitted bt the supervising physician.
This articke Dr. Menowsky is referring to is discussing Nurse Practitioners in Minnesota, and NOT Physician Assistants.
As PA’s, physicians have a major role in our training. PA’s are trained in the medical model. We are licensed by the same Board as physicians. And most importantly, we are dependent practitioners. That is, we must (by state law), have a supervising physician. I believe most PA’s realize we are not doctor’s. We are taught to NEVER allow a patient to think we are doctor’s (even if we possess a doctorate degree).
Please do not confuse PA’s with NP’s when discussing the NP’s desire to be independent nurse practitioners- practicing nursing, not medicine.
Thank you for allowing me to comment on this issue that I think is going to come to a head sonner, rather than later.
Respectfully submitted,
David S. Pecora, PA
March 23, 2015
Thomas Chambers PA-C, MBAPrescriptive practice, as all healthcare policy should to be, needs to be patient oriented, not provider centric! Physicians remain and will always be the leader of the healthcare team, especially in emergency medicine. Although PA’s and NP’s tend to be thrown into the same bucket by Physicians in the APP world, a critical difference exists. PA’s are “dependent practitioners” under state law, meaning they must work hand in hand with a supervising physician. NP’s are allowed “independent practice” in many states. Although PA’s and NP’s may function in a similar fashion in your ED, training and practice law is significantly different. Thus, when a PA prescribes a medication, they are doing so with and under the supervising Physician’s approval. Dr. Michael Menowsky, MD, RN, BSN fears are unfounded in respect to PA’s, however, his fear regarding his nurse colleagues may be justified, but, knowing my NP colleagues, I doubt it!
March 23, 2015
John CastleThe question is NOT if they should have prescriptive rights, but should they be independent. As a PA, I stand foursquare behind the PA doctrine that we will only practice under the authority of our physician supervisors. I agree that “mid-levels” should not be practicing independently, and that’s one of the core disagreements between the PA & NP professions. Now that I’ve addressed that fundamental issue, let’s examine the prescriptive right.
If I work for you, and if you have full confidence that I’m not a loose cannon and that I know my limits — strengths and weaknesses — do you really want me coming to you to sign each and every Bactrim RX for a UTI? Do you want me hanging outside the room where you’re seeing a patient, thus wasting my time while I present to you my DX of a child’s ROM so you can sign the amoxicillin RX? I don’t think so. Time is $$$, and you hired me to keep the ER’s statistics down so that the feds will stay off our back.
In summary, the issue is really the supervision and independence of the practitioner, not the ability to write a prescription. If you don’t trust me to do that, then you can’t trust me to see patients and DX that pt. The studies all point to the fact that PAs don’t have any more malpractice claims against them than you do. If you have a problem PA working for you that you can’t trust, then fire him/her. But don’t make your work more odious by finding me leaning against the wall outside the room where you’re working. Let me have those prescriptive rights if you trust me. If not, fire me.
March 23, 2015
Matt AndersenI’d like to see if the author of this opinion has any evidence to support the argument that NPs or PAs are unqualified to prescribe medications (or perform procedures such as arterial and central venous lines).
March 24, 2015
Jeff KelloggHumm
Interesting thoughts
Problem that I see with it is it is just an opinion.
I have watched MD/DO over prescribe narcotics purely for the profit and the inability to say “no” to patients, or other misguided reasons.
PA/NP are still a FAR minority in the prescribing world and yet we are facing a catastrophic situation with over prescribing of narcotics – which is almost 100% at the hands of the PHYSICIANS – I believe that ANYONE carrying a DEA number should have to attend specific training on narcotics to so we “first do no harm” and I think if you look into this it is your profession which has created this.
So, stop throwing stones if you are living in a glass house.
As for PA and NP prescribing habits. I see nothing particular about them, nor have I ever read any studies or evidence that the care delivered is inferior o MD/DO – and in fact have read a few which state the opposite – ie NP provide BETTER Diabetes education.
Every is entitled to an opinion, even if it is wrong……
March 24, 2015
Jeff KelloggMany states, including Alabama where I practice, have allowed NPs to place CVLs [central venous lines] and art-lines. I’m very opposed to this and have written to the medical board speaking out against it. Physician leaders are asleep at the wheel on this topic.
Wow, that is just a very strange sentence/thought
PA and NP are commonly staffing the IR labs where the hardest access patients are sent to get lines placed. It seems illogical that an entire profession is wrong, and that all the RADS that are relying on PA/NP to run their labs, and hiring them as partners would be so wrong.
Sorry but it seems that you are misaligned with your comments to what the current USA medical delivery system entails as well as what evidence has shown.
I for one am very happy when a a provider (any provider) is able to get access on my patient when no one else in the hospital could get it. I don’t care about the titles and initials after someones name, but instead is the patient getting the best care possible. And yes I have placed over 300 PICC and central lines and vas caths, many on patients with horrible access that others could not get.
March 25, 2015
Clint Kalan, PA-CI am truly sorry that this author is of the opinion that, as a profession, PA’s and our NP collegues do not have the needed knowledge and skill set to prescribe medications from our departments. I feel as though this is one of the least mentally taxing things I do during my busy shifts (when compared to the rigors of the diagnostic process). I feel as though my prescribing pattern very much mirrors that of my supervising physicians.
As far as the implication that our profession is invading a professional and monetary “turf” of emergency physicians, I would invite the author to read position statements of SEMPA and AAPA about supervised practice. I would also put forward just one small example of how we are benefiting the financial situations of our physician colleagues: my own practice. I work collaboratively with my supervising physicians in a democratic physician owned practice, in which I am reimbursed about a third per RVU I generate as compared to my docs. As PA’s we help offload a large portion of the non-critically I’ll workload, address the critically I’ll workload when our docs are over tasked, keep door to prouder time under 20 minutes, and help our physicians to practice the medicine they love and live well. With funding for GME unlikely to increase, the burden placed on our ED’s certain to increase, and the workforce issues we already have (especially in rural areas), PA’s are good for doctors, good for patients, an good for keeping our ED’s working in their best capacity.
I’m sorry the author of this comment does not share my view. I would invite him to come work with any of the talented PA’s above, and would anticipate his view may shift.
March 25, 2015
janeDr Menowsky: Im not a doctor and I know it. Im a Physician ASSISTANT. I have no problem working under the supervision of a physician. Actually though, some procedures EG line placement, seem the best utilization for PAs, This is a technical, trainable and a time consuming task.
I do not feel APPs (formally know as MLPs) should have independent practice either.
Delegation and training make your PA what they are and what they can do. You don’t want your PA to do something without your approval? Don’t give it
March 25, 2015
ClayOk, now I’m going to use the same logic you used to discuss your degree. So, you were a Paramedic first, then went to nursing school. So, your undergraduate degree and course curriculum was not as rigorous as those of us who obtained a “true” pre-medical undergraduate degree. Therefore, your “lack of education” should allow us to assume that you are not up to par with MDs who obtained their degree the “traditional way”. After all, as a nurse, you couldn’t possibly expect to do well in med school with a BSN, right?? And, if nursing education is so substandard, why do you include RN, BSN after your MD??
You represent the biggest obstacle to healthcare delivery! Instead of looking at “mid-level providers” as partners (which you are the head of), you look at us as competition! Check the stats on patient outcomes and patient satisfaction when healthcare is delivered as a TEAM before you invoke your “call to arms”!
March 25, 2015
Rich Woller, PA-C, MPADr. Menowsky,
I am reminded of what a number of surgeons have said about their craft – that they could teach nearly anyone the technical skill of surgery. It’s the death and dying that takes years of practice to deal with. Putting in central or arterial lines is a technical skill that can be taught to MD, PA or NP alike. You don’t have to be a genius to do it. See one, do one, teach one – remember? I, too, would be upset if I were you. You spent all of those years slaving away in a medical education system that is indentured servitude at best while we PA’s and NP’s worked are asses off for 2 years and get to do mostly the same things that MD’s do. We also spent a heck of a lot less money. Numerous surveys point out that MD’s are a very unhappy bunch while PA’s and NP’s are extraordinarily happy with their work. I would suggest you seek counseling because PA’s and NP’s working at a very high level in medical care are not the cause of your misery.
Good luck
March 25, 2015
John BielinskiPlease forward this message to Dr. Menowsky. Dr Menowsky, you are clearly concerned about your profession. It’s respectful that you have climbed the ladder of medicine, from medic to nurse to EM physician. That’s impressive. Very impressive. Impressively impressive. Here’s my question: how can we best serve patients? If it by limiting the scope of practice of PAs/NPs? If you can honestly say, “we can better care for people’s health in the United States by limiting the prescribing privileges of John Bielinski, PA,” then I am all for it. But, if this is really a concern for your job, position and stature, well sir, that is a position based on selfishness and self-preservation. I understand that I, as a “lone wolf” PA – that place central lines, push thrombolytics (AMI) and uses RSI for the critical patients I see in the critical access setting must be disturbing to you. Who else would staff it? Are you willing to staff a critical access ED for the money they can afford to pay with a annual patient volume of 6K? Of, would you rather a family practice physician, that hasn’t taken ATLS 4 times, or took Ron Walls, MD’s Airway Course? This is threatening times to some physicians due to the role of PAs/NPs. With the health care system going bankrupt, the solution is not more physicians. It’s more physician extenders. Period. I have tremendous respect for physicians and am honored to care for patients along side of some amazing doctors, nurses and medics. So, there are two options for you Dr. Menowsky; enhance yourself in your capacity or attempt to tear down the “competition.” It’s know as “tall poppy” syndrome in Australia. Grow tall…. OR…. cut down those around you. Good luck Dr. Menowsky. Find peace as a physician. I love being a PA. Peace.
March 25, 2015
Leonard ChornockJust wanted to thank Greg for defending us against this unwarranted attack! I have been practicing EM for 30 years and I am guilty of doing all the procedures he is against us doing! Thank G-d I work for a group of physicians that see the value in my services. Maybe he needs to change locations, so he can see how things work in an ER that really respects the PA’s and NP’s and is committed to continually providing further education and role enhancement.
March 25, 2015
Nancy McGeorge, MS, RPA-CReally Doc? I have the same background and training as you. I took the same undergrad, and similar first year medical school, no I did not do a residency. No, I can’t recite the Crebs Cycle, though I know this comes up daily in your practice, I can appreciate it and explain the concept. I know what I know and more importantly, I recognize what I don’t know. I can’t say the same for all the Physicians I have worked with. I am thankful for the Physician I work with, who appreciates and respects my experience and knowledge. And I am grateful I don’t work with you.
Jeffrey Rabrich Nancy McGeorge I always find it interesting when physicians choose to bash PA’s or NP’s. I too was a paramedic, then a PA and now an Emergency Physician. Clearly they are not needed in Alabama due to their “outstanding” emergency care. As you can see form their 2014 ACEP report card http://www.emreportcard.org/Alabama/ , they scored an overall “D” with “F” for access to care and public health/injury prevention. SO tell me doctor, if you state is so poor at access to care what is you solution after you stop all the APP from seeing patients in your emergency department. Yes I agree that they can’t do everything you can as a physician but lets start with you example of place a CVC. Since you were a paramedic, you know anyone can be trained to perform a procedure like intubation, chest tube, CVC, etc. it’s the higher level decision making of the why and when that physicians excel at. So no they can’t “replace” doctors as the leader of the health care team nor should they be the sole provider managing a cardiogenic shock or multi-trauma in the ED but since only 5% of ED visits are true emergencies they are quite capable of managing most routine visits. Finally, every APP I have worked with have had no problems recognizing their limitations and asking for help or advice when needed, nor have I ever had one misrepresent themselves as a physician. As the director of a Level I trauma ED with 100K+ visits, I am always looking for good PA’s so send yours to me if you don’t want to work with them. My 2cents.
Alabama
Alabama continues to support Disaster Preparedness systems and has worked to maintain an adequate Quality and Patient Safety Environment. However, the state continues to struggle with workforce shortages related to <em>…
EMREPORTCARD.ORG
March 25, 2015
TracyDear Mike- Please do the Nursing profession a Favor and resign your nursing license. If you consider yourself a credible physcian, check the safety data of NP prescribing and it will show you that the medical profession has issues in which more education is needed! You need to get over your perception that your MD credentials are anymore important than anyone elses!
March 26, 2015
AmandaFYI, the Institute of MEDICINE has released their official statements that nurse practitioners are safe providers and “should be allowed to practice to the full extent of their education and training”. That includes advanced pharmacology, advanced assessment, etc. Numerous studies have shown that NPs have equal or better outcomes than their other provider counterparts. In addition, patient satisfaction is generally higher for NPs than physicians. NPs & PAs also have dramatically fewer lawsuits than physicians and in Oklahoma, NPs make up only 3% of the top narcotic prescribers. NPs & PAs are very judicious in their prescribing habits.
March 26, 2015
David Alden-St.Pierre, MS, PA-CGreat responses from many of my PA colleagues. Now, I look forward to support from the MD’s and DO’s that we work side-by-side with.
March 27, 2015
John Hardin PACrickets…
March 28, 2015
Dave Mittman, PA, DFAAPAIt is thinking like this that really makes the team concept seem like a poor idea. Why anyone would publish this is beyond me?
I have been prescribing “just like a physician” for 39 years. Why does this physician think he can question my ability? Truly, tell me why? I have not made any crucial mistakes, I am always willing to learn and I really watch what I do. People actually also get better when they see me-imagine that.
How dare you question my ability like that?
Dave
March 28, 2015
MargaretI do not even know where to begin here. I have periodically read the newsletters from various medical boards in states in which I have worked over my 28 years as a PA. In the section listing providers being sanctioned or having revocation of licenses, invariably there are numerous MD/DOs listed. More than a few have been narcotics-for-sex, in which the physician not only lost his/her license, but went to prison.
When I worked in oncology, the other PA and I were far more judicious prescribers of GCSFs than the fellows with whom we worked.
I have also seen numerous instances where I have denied a patient an antibiotic for a viral illness, only to have them go to the ED or urgent care and be prescribed a Zpak by an MD.
Mostly, I feel sorry for the author. NPs/PAs are here to stay. You cannot unring that bell. We have a track record of over 50 years in which we consitently have provided high quality care to many patients. If we were so dangerous to the patient, we would have been long gone.
I agree with the others that this is far more about ego and $$$ than it is about patietn safety.
I am grateful to work with many wonderful doctors who appreciate my skills and do not feel in any way threatened by me. Honestly, there are plenty of patients to keep us all employed. An indiviudual who is self-confident and content does not feel the need to tear others down. Only small, angry people behave in this manner.
Perhaps, instead of an emotional rant, the good doctor can write a piece in which he actually presents data and facts to support his views. Anecdotes don’t count.
I suspect we will hear crickets.
March 30, 2015
Amy, PA-CWow, I half expected this to end with a “And get off of my lawn!” I’m afraid the ship has sailed on the matters that are upsetting Dr. Menowsky. Training more PAs and NPs and allowing us to practice to the full extent of our training is the answer to increasing access to care for all and keeping costs under control. I’m sorry he doesn’t see that. Training physicians is time consuming and expensive and you don’t need 8 years of training post college to do 90% of what all the providers I work with do on a daily basis. MDs will always have a role on the healthcare team of course but does it really make sense to only have 1 person in the ED that can do these advanced procedures that you are so protective of? I know the doc’s I work with don’t want me to bother them unless I have a problem. They are busy too and I’m expected to be able to do my own procedures and prescribe my own medications, and they happily give me the autonomy to do just that. You can teach a monkey to do the procedures that you claim to be so advanced.
I also had to chuckle at his statement that physicians used to be at the top of the corporate healthcare structure. Perhaps they aren’t there anymore because they weren’t doing a good job?
I have had the pleasure to work with many PAs and NPs that are awesome at their job and I have gladly trusted them to take care of my friends and family. Dr. Menowsky’s opinion is insulting and ill-informed and I am so happy that I don’t not work with any physicians like him.
April 2, 2015
Dennis Talbot, PA-CI have only one question to ask the doctor. Do you treat illness and injury any different than the 1000’s of PAs and NPs that are trained to treat illness and injury?
You treat acute sinusitis with the same remedies I would as a PA. You treat hypertension with the same remedies and modalities as I do as a PA. You treat acute pain with the same remedies as I do as a PA. You (as an ER doc) know when to call in a specialist, just like I do as a PA. So I don’t get what your argument is about prescribing. Did you learn some form of alternate medicine that I am not aware of?
Let me be preemptive, knowing what your response is going to be. I DO NOT have 4 years of medical education and 3-4 years of residency. I may not be able to care for the most complex case that the ICU Intensivist is caring for now. BUT (with my background, extensive education, and clinical skill set as a PA) I am pretty darn sure that I could learn that medicine. Guess what, I am pretty sure as a non-ICU doc, you would have to learn that medicine just like I would.
Sonny
April 2, 2015
James Earl KochNoting that this article is in ACEP Now-The official Voice of Emergency Medicine!(I added the exclamation point) I would suspect that many physicians have read this pathetic article. However, as I peruse the comments left here, the majority I see are from NP and PA providers. Where are our physician colleagues, weighing in to defend us against this obviously biased, wrong, and emotional article? Should not we have heard from at least 1 physician commenting on his or her excellent PA/NP and the great job they do everyday? I have worked with very few physicians that actually embody the “team” concept as it is advanced by the AAPA. Most of the time, I feel as if I am a lifestyle enhancer for the physician that I happen to be working with. I would like to see our team be more than words-spoken, or on paper. I would like the team to be more than an outdated concept-my opinion, and instead be a reality that is seen nationwide. We are not physicians, and we don’t pretend to be. We are excellent medical providers-not midlevels! We deserve to be recognized for this, and treated as true partners in healthcare. We are in it for the patients correct?
April 14, 2015
Dave Mittman, PA, DFAAPAJames: You hit the nail on the head.
This guy seems to me to have little need of advocating for his team members and much more of cutting them down. For reasons only he understands, he wants to restrict me from doing what I have been doing long before he ever became an RN, let alone an MD.
Sorry.
Dave
April 26, 2015
ScottI don’t feel I need to respond to the original opinion piece that started this thread as the previous responses have more than adequately covered it.
What bothers me is the lack of physician feedback. My only hope is that the title (Opinion: Nurse Practitioners, Physician Assistants Should Not Have Same Drug Prescribing Authority as Physicians) was so droll and and uninteresting given it’s antiquated stance to current practice, that our physician colleagues didn’t even bother wasting the time to click on it.
Perhaps it’s the type of nonsense that only those it’s truly directed at had to take the bait. Maybe its trolling, but I think it is just someone saying what a lot of others are thinking. It would be nice to be proven wrong and have not only APP’s respond to such an affront of our professions. Out of 26 response it seems no physician speaks to our value on this shared site, which likely has far more physician readers than APP’s
I can assure you of one thing, if the tables were turned and an opinion piece leveled such dissent at the value of physicians suggesting APP’s could fulfill your role, it would not only be physician responses because we would have your back as well.
April 28, 2015
Clinton Ray PA-CUnfortunately these attitudes to PA practice still exist. Let me just briefly share a story in which I interacted with a Surgeon regards a trauma pt. For about 6 years I covered a rural, underserved community hospital ER. No physician for 30 miles in either direction. We handled everything and shipped out a lot of critical medical and trauma patients.
One particular night I am treating a female patient with a GSW to the left upper quadrant of the abdomen. As we are attempting to stabilize the patient, I get on the phone with a trauma surgeon at a regional trauma center in order to give him report in hopes he will accept pt for transfer. At this point he begins to chastise me about how there is no surgeon at our hospital to “clear” the patient to get on a helicopter. At least one third of my entire conversation was defending the fact that we in particular and rural america in general does not have surgeon and sometime not even physicians available to care for these patients. He eventually submitted and accepted the patient in transfer.
Funny how like minded physicians who work in large urban facilities with every subspecialty available to them aren’t willing to offer their services to rural underserved community at salaries that we PA’s and NP’s will accept.
May 3, 2015
DavidAdvance Practice Clinicians are an growing part of our healthcare system and have a skill range that is as variable as the physicians in this country. To focus on prescribing ability for certain medications is myopic. The greater focus should be how to best integrate this folks into medical practice.
If we as physicians manage APCs appropriately, they can be extremely valuable additions to the medical care community…and a necessary part as we continue to have provider shortages and need to become more fiscally responsible. In some states APCs that are Nurse Practitioners are able to have independent practice with perception ability. Most of these NPs are very well educated and if they did the proper residency type training very good clinicians.
In my opinion, it is the uniformed that are most vocal against APCs integration and practice in healthcare.
May 14, 2015
GaryWow, angry are we not. Hey Doc I have been a NP for many years and no I will not be called a Doctor even if I went back and got my DNP. I am a NP, independent practice? Do not care love working with my physicians in the ER however I would like to be able to Rx. Schedule II without bothering my doctor for a Signature.
June 24, 2015
Misty, RNTo whom is may concern. I am an RN, and of course would never presume to be more than I am, but just had a few thoughts on this. I really appreciate all the MD’s I work with. I do want to speak to the need for health care providers who are able to serve the needs of the community. Healthy People 2020 goals are calling for more NP’s and PA’s. Many communities are underserved and have a high patient to MD ratios. We need MD’s, PA’s, and NP’s to fill these holes in care ASAP so that the underserved can have primary care providers. For people who have no one at all to write them a prescription, I find this to be a sad conversation. Also, patients are often able to choose their own healthcare provider and if they are not comfortable with a PA or NP they can choose to see a MD.
April 21, 2017
Stacey DwyerDr. Menowsky, I understand feeling compelled to protect your title and your scope of practice. However, it has to be reasonable. As an RN, I don’t have an issue with less skilled team members carrying out duties that use to only be done by nurses. We need MA’s, CNA’s, PCA’s and so on. The healthcare system has to find ways to provide quality care that is cost efficient. What I have grown to learn is that the nurse’s scope of practice is changing. Other’s can be trained to carry out technical tasks. Nurses are utilized for their knowledge and experience. I think that you have to look at your position differently. Rather than trying to prevent others from doing things they are capable of doing and well-trained to do, consider what makes the physician different and focus on that. I believe that you see yourself as more than just one who carries out task or prescribes medications. As a physician, you are such a valuable resource to the entire medical team, including the NP’s and PA’s. Physicians will never become obsolete. The NP or PA will practice according to their fullest ability and when the situation is more than they can handle, they will refer to you.
The biggest issue I have with your post is when you commented about having reimbursement tied to performance. Why is that a problem? Do you think you should receive a blanket amount just because of your credentials? Almost every service in the world receives reimbursement rates tied to their performance. Additionally, this type of reimbursement is there to help improve the quality of care, not to punish. As a physician, shouldn’t safe and quality care be your number one goal? If it is, than you shouldn’t have any issues regarding reimbursement.