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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.
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....
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.
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.
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.
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