Scope of Practice


PAMED Approaches Health Care as a Team

Earlier this year, Senate Bill 25 was introduced that would grant full practice authority to Certified Nurse Practitioners (CRNPs). Current law requires nurse practitioners (NPs) to practice under a collaboration agreement at all times, but the bill would permit qualified CRNPs to practice independent of a physician after fulfilling a three-year, 3,600-hour collaboration agreement.

While the Pennsylvania Medical Society (PAMED) understands and supports the important role that CRNPs, CRNAs, nurse midwives, and physician assistants play in patient care, we also believe that there is a need for physician oversight, whether by direct supervision or a written collaborative agreement, of all non-physician practitioners.

Current PAMED President F. Wilson Jackson, III, MD, agrees: “the strong feeling is that a physician-led team is the best approach to patient care, (and) nurse practitioners are an invaluable part of that care team.”

JacksonTeamDr. Jackson’s practice includes several nurse practitioners (NPs), who are an integral part of the patient care team, and he stresses the many positive benefits of establishing a collaborative environment.

“I think it’s terrific for the patients…. there’s that reassurance - they know that there’s a team approach,” Dr. Jackson says. “I think from a patient perspective, which is central to everything we do, the patients have that reassurance that there’s a backup plan in place should questions arise.”

jacksonpatientPracticing in a specific subspeciality in gastroenterology, Dr. Jackson sees a lot of patients that were referred to his practice from both physicians and non-physicians when a patient is experiencing signs of something more serious or complicated going on with their symptoms. At those times, he says he essentially must start over with a patient instead of just continuing their care.

“Any practicing physician has been in a similar situation where, in hindsight, something more serious was going on with a patient that could have been picked up earlier,” he says.

John R Mantione, MD, an obstetrician-gynecologist in Hummelstown, currently has a newer grad NP working with him and keeps in close proximity while they are having patient interactions or charting. He believes that it works well to have physicians available for back-up if needed, when different expertise is necessary, or in cases where NPs don’t have enough time to see a patient.

“For (NPs) to practice at their highest potential seems to be in a collaborative setting. If you look at the number of hours my NP has trained and has her certification that says she’s ready to practice, it’s not the same level as a fourth-year resident."

John R Mantione, MD

In his practice, Dr. Mantione says he, too, has had patients come through that were seeing a NP at a different family practice setting, and there were more to their symptoms than what was originally understood.

“On paper, the care the patients received met the standard that was required but there is recognition that there was more to their symptoms that I think could have been picked up earlier.”


Both physicians firmly believe that maintaining oversight should remain an essential component of the non-physician practitioner relationship, and that continuing to maintain this oversight leads to better outcomes for everyone involved.

“There’s no question in my mind that having a healthy dialogue back and forth around patient care is really productive,” says Dr. Jackson. “I think it’s also mutually educational. Sometimes a nurse practitioner will pick up certain aspects of the patient’s medical history or story that is relevant to the physician - that’s important as far as patient care. So having that team approach, I think, allows for a more dynamic, collaborative approach to patient care.”