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Monday, November 20, 2017
HomeHealthCeteraAccess to Care and Scope of Practice

Access to Care and Scope of Practice

My latest blog post for JAMA News Forum focuses on access to care and scope of practice:

I wrote it right before NYS passed a budget that removed the written practice agreement requirement for experienced NPs in the state but was able to add mention of this in the blog. The new law still doesn’t remove all scope barriers and a sunseting clause will require continued vigilance. It’s a step forward but more needs to be done.

I welcome your thoughts.


Latest comments

  • As a Nurse Practitioner who previously worked in a red (restricted) state as identified by the AANP map of full practice, reduced practice and restricted practice, I welcome the less burdensome arrangement experienced nurses will have starting next year in New York. Under the current law, I cannot legally even volunteer my NP services without a collaborative practice agreement. With the NP Modernization Act of NY passed on April 1st, should I decide to open my own practice, I will no longer have to worry about my collaborating physician taking off for the Bahamas permanently, or dying or just deciding it’s time to retire. I will be able to practice and collaborate like the grown up professional that I am without the State Education Department wagging its finger at me to get my paperwork in. Yes, there will still be paperwork, but I will keep it, not the state. The irony of all this collaborative practice agreement nonsense is that any of the physicians with whom I have worked have thought it equally cumbersome and unnecessary and, frankly, didn’t want to be bothered reviewing my charts every 3 months or more often. When I worked in a restricted state with a supervisory (rather than collaborative) relationship, the rules were that in a rural health clinic 10% of my charts were to be reviewed every 10 business days in the place of business of the NP during normal working hours. My supervising physician routinely cancelled these bi-weekly meetings. One day I found the office manager trying to spirit charts out of the clinic where I worked alone over to the physician’s office because he didn’t want to come to me. When I told him what the requirements were for me to practice legally he asked me whose idea that was. I told him it certainly wasn’t mine and that some of his physician colleagues lobbying in Austin, Texas were imposing these additional burdens in the name of patient safety. I kept a list of a year’s worth of cancelled “supervision” visits. This physician, by the way, when he wasn’t “supervising” me, was sleeping with his patients and was sanctioned by the state ultimately. So much for patient safety.

    So, having worked under those conditions, I am relieved that the NPMA passed. Is it as good as full practice authority with absolutely no reduction in practice? No. Is the ACA with its private insurance exchanges as good as single payor insurance? No. But both of these pieces of legislation are a step forward. There is still an awful lot of work to be done and we cannot rest on our laurels, but I am grateful to all the advocates who worked so hard to get us to this point and it will make my life as a nurse practitioner that much easier and, more importantly, give patients greater access to care. Now that I am less worried about which form gets submitted to the state, I can turn my attention to and focus more of my energy on providing excellent care to my patients.

    • The proof will be in three things: the form that the State Education Department comes up with (it could be just another form of the written practice agreement); the number of NPs that opt for the form instead of the written practice agreement (and I’ve heard that some are preferring to stay with the written practice agreements because they see them as legally safer, again, depending upon the SED form; remember that failure to produce the evidence that the state can ask for can result in charges of professional misconduct); and the political context in 2021 when the law sunsets. Connecticut just got full practice authority, and other states are also bringing down this barrier. Since the NYS Medical Society opposed the NPMA and the word is that legislators have grown tired of their turf-protection stance, the IOM report and the ACA’s creation of the need for more primary care providers suggest that all forces were aligned to bring about the change that we wanted–full practice authority. Kingdon’s policy streams model provides the framework for illustrating that the timing was right to go for full practice authority. Hopefully, they will be aligned in 2021. If not, you’ll be back with what we’ve had now for years.

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