By Sam Unterricht
As New York’s health care delivery system becomes integrated, state policy-makers must assure that safeguards that have historically existed to protect patients remain in effect.
One such safeguard has been the legal requirement for a nurse practitioner to maintain a written practice agreement and collaborative relationship with a physician. Nurse practitioners are demanding that they now be allowed to practice in an unsupervised manner. While nurse practitioners are valued members of the health care team, the current safeguards exist to protect patients.
There are very significant differences in training between physicians and nurse practitioners. In addition to four years of college and four years of medical school, a physician must complete between three and seven years of residency/fellowship training. By the time the physician begins to practice, he or she has already devoted the required 12,000-14,000 in patient care hours.
A nurse practitioner completes a four-year nursing program and a two-to-four-year training program. When he or she begins to practice, a nurse practitioner has delivered only 500-720 in patient care hours. That difference is significant, both in terms of quality and cost of care. A physician’s additional years of medical education and training are vital to the health care team and optimal patient care, especially in the event of a complication or medical emergency.
If the law is changed, what will change? First, the quality of care that our patients currently benefit from will be adversely affected. Patients don’t really understand what a written practice agreement or practice protocols are, but they have enjoyed the benefits they bring. Their records are reviewed by a physician to assure that the standard of care provided has been met.
Another important facet of this issue involves the cost of care. Some entities support this proposal because they think they will save money. Nurse practitioner salaries are somewhat less than that of a primary care physician. However, studies show that this differential may be offset by increased utilization of tests and referrals by NPs to specialists for consultations due to lack of diagnostic ability.
Rather than establishing additional unconnected silos of care, New York should be pursuing laws that assure greater integration and care coordination, not less. Doctors and nurse practitioners need to work in a coordinated manner to ensure patients get the care they need. And highly trained physicians should, in each and every case, lead the patient care team.
Sam Unterricht, M.D., is president of the Medical Society of the State of New York.