Two physicians connected with Becker's to share their thoughts on the push for increasing responsibilities and scope of practice of physician assistants and nurse practitioners.
Q: How do you feel about the increasing medical liberties given to PAs and NPs?
Note: Responses have been lightly edited for length and clarity.
James Alexander, MD. Chief Medical Officer of Integritas Providers (Carbondale, Ill.): Having midlevel providers in any practice seems to be the norm now. My wife is a PA-C and has been for 20 years.
The question deals with increasing their liberties. With that comes more responsibility and liability. I seriously doubt advanced practice providers pay more than the average internal medicine or pediatric provider for malpractice coverage. I have been deposed many times on patient care issues but I've not been sued for malpractice … yet. Depositions are not an enjoyable experience for medical professionals with years of education and training. I cannot imagine doing a deposition with a BSN, MSN, and a few hundred contact hours.
Unless I am totally mistaken, physician assistants are trained by physicians, for the most part, and nurse practitioners are trained by other nurse practitioners. Physician assistants are required to retest every seven to 10 years like most new physician residency graduates. Nurse practitioners do not have to retest for proficiency in their medical knowledge. Once certified by the board of nursing, why are they not held to similar standards created for physicians and physician assistants. Does this make them more of a liability? Are they knowledgeable enough that they are more responsible to be granted these liberties? Not all states require physician assistants and nurse practitioners to have a collaborating physician, according to the American Medical Association. The AMA's Scope of Practice seems to be more limiting to physician assistants than nurse practitioners. The confusing part of the AMA's State Law Charts on Practice Authority for both is that not all states require nurse practitioners to be supervised for any hours before they are allowed to practice "autonomously." The same verbiage is not in the physician assistants' Practice Authority guidelines created by the AMA. Jokingly, I just figured the nurse practitioners had better lobbyists.
Lastly, physicians, advanced practice providers and nurses were the heroes of the COVID pandemic. Those ideas did a rapid, 180-degree turn in less than a year. When will the COVID-related class action suits start hitting prime-time TV commercials like talcum powder and RoundUp? Will we see another malpractice fiasco like the one in the 1970s and '80s that lead to the practice of defensive medicine? I don't recall ever getting hazard pay or being paid to stay home.
My final comment is this: With the direction medicine is taking and the possibility of more pressure from everyone, why in the hell would you want more liberties?
Javier Marull, MD. Anesthesiologists and Medical Director of UT Southwestern Medical Center (Dallas): I think medicine is about teamwork, and in our department of anesthesiology and pain management, PAs/NPs play an integral part of the anesthesia team, especially in the presurgical testing clinic, where they help physician anesthesiologist-led teams prepare patients for surgery.