re: SB 435 would allow advanced practice nurses to not work under a physician

FYI it passed Senate Committee, headed to the Senate Floor.

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I am a physician and its a terrible idea.

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I wonder why?

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I wonder why?

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Scruffy works daily with NPs.

This is an awful idea.

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Scruffy works daily with NPs.

This is an awful idea.

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Awful idea for who?

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If they are working at an Urgent Care seeing routine sore throat/cold type things or a Minute Clinic for the same types of issues, probably not as a big a deal as say diagnosing and treating complex cardiovascular issues. Then again, I'm no physician. So, I would think it pretty important to have lots of physician input on this type of thing.

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While your thought is correct- most cases of sore throats and colds seen in urgent care by a mid-level, medical student, or even a good mother aren't that big of a deal, every now and again, they are quite complex. People don't walk in with diagnoses, they walk in with symptoms. The line between "sick" and "not that sick" can be very fine, and it takes quite a long time to get good at distinguishing it. There are plenty of severe, complex diseases that begin with cold-like symptoms.
Medical school requires a bachelor's degree (or damn near it with very very rare exception) followed by 4 years followed by a minimum of a year of residency to be independently licensed. The State Medical Board is actually about to increase the requirements for US grads from 1 year of post-grad training (and 3 for IMG) to the completion of a residency for everyone.
So you've got a self-regulating board increasing the requirement. They also will require, in general, that basically anything you choose to do with your license is fine, but you will be held to the standard of a board-certified physician in that field. What does that mean? If I have x-ray in my office and bill the patient for it and see a pneumonia but miss a lung cancer that the average radiologist would see, then I'm not practicing up to the standard required to use x-ray in my office. I am, of course, trying to keep this simple.


On the other hand, the state nursing board is pushing to allow people with a bachelor's degree in nursing who have completed a curriculum which is frequently done online and part-time while working full-time as a nurse with very little clinical training (sometimes as short as about 3 months, not structured as a formal residency program or med school rotation would be) to be able to practice medicine independent of the state medical board and held to a standard to be decided by the board of nursing.

I am an engineer and not a medical professional but your premise is extremely sound and reasonable.

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They aren’t doctors

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What if they get a DNP, though?

I can't wait for that frick-stick physician to come in here and melt again.

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Scruffy works daily with NPs.

This is an awful idea.

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Isnt Scruffy still a resident?

Some of those NP's probably know more than you..

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What if they get a DNP, though?

I can't wait for that frick-stick physician to come in here and melt again.

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So my question for you is if passed will you require NP's to carry malpractice insurance as well?

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your premise is extremely sound and reasonable.

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I am trying to give relatively objective information without opinion with that post. There's also some data showing that they don't go to areas of shortage and, just like MDs, go to cities and overserved areas because they're desirable. I don't have it in front of me but could find it.


My personal opinion is that there are a lot of great options out there for medical teams to evolve, but this is not one of them.
Independent NP practice is fine (in my book) if a) the area is underserved (and I'm actually +/- on that but tend to think if the argument that they're truly needed to give care to the sick is what they're using, they should stick to it) and
b) they are held to the same standard as physicians practicing independently. By all means, I don't want less providers out there. I want anyone willing to practice at a high standard practicing. I do think their level of training minimums do not give them enough experience to do that at a high level, but this would allow them to seek further training and put in on the line if they were to feel confident enough in their abilities down the line or after having attended a more rigorous training program after years of bedside nursing.


What I can't confirm but always hear is that this is usually offered in the negotiation and shut down by the nursing board or countered with allowing nurses/NPs onto the LSBME. Problem there is that you then have nurses dictating the standard of care for physicians, which also becomes less than ideal for both parties.