Scope of Practice Update: State Rep Proposes CRNP Pilot Program in Health Professional Shortage Areas

9 comments

1. D. Michael Baxter | Feb 16, 2020

   CRNPs or Advanced Practice Nurses (APNs) are a vital part of the US health care system and work well in supervisory partnership with physicians.  The health needs of rural communities must be a priority.  However independent practice for APNs may actually undercut efforts to address rural heath care deficiencies.  To see who is currently providing this care explore the rural health “mapper” at www.graham-center.org.  For over30 years while teaching med students I have encouraged many to enter the discipline of Family Medicine.  Let us be clear that independence for APNs establishes a new pathway to becoming a physician.  Since the Flexner Report of 1910 the requirements to become a physician required 4 years of vigorous biomedical education in a certified medical school followed by post graduate training.  Why would a bright student say coming out of Temple with $200,000.00 of debt train in a primary care field where the may compete with an independent APN down the street with a fraction of the training, debt and malpractice costs?  The way to address rural needs is for PA to get serious (as have other states e.g. N.Carolina) about recruiting and funding students (scholarships) who will serve rural areas and then training them at residency sites with the specific skills needed and supporting them in these challenging practice settings.

2. Matthew Levin | Feb 13, 2020

   Nps have 1.5 years post college training.

   I as a board certified FP have 7 years (3 years post graduation).

   Also, how many NPs are planning on working in "shortage" areas, or even in primary care.

   If a practitioner spends more time with a pt even if the dx/treatment is not adequate, my experience is the pt perceives the experience as "better."

   NPs should work under supervision of physicians.

   However, I suspect that the number of lawsuits that go forward as well as the increase in liability insurance accordingly will impact the number of "true" independent NPs.

   I am fearful that institutions that have to staff up Urgicares will use these individuals and "burn them out."

   My area of Western PA is oversaturated with NPs, so many find that they have to move to get work.

   I am also suspicious on who is "championing" this independence drive, the NPs OR the instutions that now will have an easier and less costly alternative to hiring physicians.

   Just my thoughts....

3. Natasha Alligood-Percoco | Feb 13, 2020

   Larry Kaiser it is very sad to see our surgeon colleagues support the wholesale replacement of PCPs with internet-trained NPs. The “paranoia“ is founded. Nationwide, employed physicians are being replaced by NPs, and communities are losing access to physician-led care as a result.

   And to your nursing research - there us ZERO data supporting the competence or safety of internet-trained NPs. In recent years we have seen a rapid decline in quality of Np education, with a simultaneous increase in scope of practice. 
   

   Turf matters because PCPs are the gatekeepers of medicine, and patient safety is paramount.

4. Franklin Bizousky | Feb 13, 2020

   I am totally against it.  Without backup from family practice board certified physicians the NP's are going to miss things and not provide the quality of care that 

   EVERYONE deserves.  In the long run, it will most likely increase the cost of medical care.

5. Ralph Bledsoe | Feb 13, 2020
   Once this is allowed, the argument of tiered care will be used for independent practice.
   Though I fear the train has long left the station, I believe rigorous standards on what the“collaborating” physician provides in oversight and education will better serve the patient. 
6. Larry Kaiser | Feb 13, 2020
   Why such paranoia? Is the argument really about care or is it about protecting turf? Are primary care physicians concerned about NPs "stealing" patients? Studies have shown that patients prefer the NP when compared to a primary care physician. Look at the studies done by Mary Mundinger from Columbia. Patients were randomized to be seen and cared for by a primary care physician or an NP. Care and outcomes were identical between the two but the patient satisfaction scores were higher for the NPs. The initial study looked at short term results but the follow up study looked long term and the results regarding quality of care persisted. Why not look at the data before reacting with a knee jerk. The DNP degree concludes with what is essentially part III of our National Board exam. HAP supports the current bill as do a number of health systems including U Penn. The time has come to allow NPs to practice to the full extent of their license like 22 other states have done. 
7. Stephen Permut | Feb 13, 2020
   I am opposed to this proposal.  It establishes two-tiers of quality of health care in the State.  Given the availability of telemedicine there is no reason why a CRNP can't continue to collaborate with an MD/DO, even if they are practicing in a remote area.  Furthermore, it has been demonstrated repeatedly that CRNPs to not gravitate to rural areas to practice.  Physicians do!
8. Natasha Alligood-Percoco | Feb 13, 2020
   As long as NPs are completing 15 month online degrees (as short as11 weeks online if they are already an APRN), we should not support unsupervised practice ANYWHERE. Rural Pennsylvanians are just as deserving of safe, high quality, physician-led care. Wake up PaMED! In 10 years primary care physicians will be extinct.
9. Virginia Hall | Feb 13, 2020

   What will the provisions be if the CRNP feels the case is beyond her (or his) training and capabilities? How does CRNP get rapid access outside of sending patient to ED? PAMED needs to review all encounters and check documentation much like we do in LifeGuard.