Better call the whaaaaaambulance: Amid coronavirus, Missouri nurse practitioners want more autonomy

Better call the whaaaaaambulance when you don’t get your way.  I’m ashamed of my former profession for trying to take advantage of this pandemic to advance an agenda. This is selfish, manipulative, and unethical. This article has to do with resulting frustration among some groups that Missouri, by relaxing some restrictions, still requires nurse practitioner-physician collaboration. The main points arguing for more autonomy in the article have been debunked time and time again. For example:

  1. many of the regulations are unnecessary and even harmful. 
  • “A lot of states right now, because of COVID-19, have taken all barriers away.”
  • But in some states — including Missouri — they can only practice with a physician’s oversight. Missouri’s nurse practitioners say this lack of autonomy hurts people’s access to care even in normal times, but especially during emergencies.

Ok. Rhetoric is defined as language designed to have a persuasive or impressive effect on its audience, but often regarded as lacking in sincerity or meaningful content. See what is happening here? The party line is now becoming that collaboration is a barrier; that collaboration is unnecessary and harmful; that collaboration affects autonomy; and that collaboration hurts people’s access to care. None of these arguments are true. These are all strawman arguments for the ultimate goal: power and full practice autonomy (FPA). I’ve written about collaboration in a prior Authentic Medicine blog ( Regulations to keep requirements for physician collaboration in Missouri remain in place according to the article. Nurse practitioners must collaborate with a physician who is within a 75-mile radius. The physician must also review a certain percentage of their patients’ medical charts. State regulations now require:

physicians still need to review a percentage of charts when nurses prescribe controlled substances. The state also waived a rule that requires an APRN and physician to practice together for the first 30 days of their collaboration.

The article reports these moves haven’t been enough for the state’s nurse practitioners. This is nothing more than a power grab. Having practiced in states with both collaboration and no collaboration, there was no difference in what I was or wasn’t able to do. This article is ripped with lies such as:

The regulation “is preventing hundreds if not thousands of health care providers from offering care in accordance with their training,”

Really? How?  This is not explained in the article. This statement is false on two fronts. I can’t think of a single reason how clinical supervision and collaboration will prevent people from obtaining care. Strawman!!  Moreover, the rhetoric “in accordance with their training.” I’ve been through NP training, and there is nothing in the Missouri regulation that prevents care in accordance with NP training. I even went to a Missouri institution back in the day for my MSN. My then training prepared me to practice fully in accordance with my training and to the full extent of my license (whatever that means) WITH physician collaboration and clinical supervision. It is the ignoramus that believes clinical supervision and collaboration is a bad idea. For example, in the past, I had clinical supervision with a 75-year-old psychiatrist with years upon years of clinical practice and expertise, and smarter than the average Joe. How on Earth would our weekly collaboration/clinical supervision meetings be a waste of time or not of value, or a barrier to anything? This was the best thing I could ever get at the time. Invaluable. Now, not all, but a few vocal members of my former profession are saying this is not necessary. Nothing could be further from the truth. I’m frustrated with the manipulation and rhetoric. I found a quote that sums it up nicely:

Hubris, arrogance is just one step ahead of loss of integrity. Because if you think you’re better than other people, you know more, then you’re going to think as many leaders have that the rules don’t apply to them. ~ Charles Koch

            Next there is more rhetoric eluding to the physician shortage. I have said many many times that the physician shortage is a physician problem to solve and not a nursing problem. 

Where it references “additional personnel” – this is eluding to nonphysician providers. It is not one discipline’s role to solve a different disciplines problems or shortages. The article then goes on to describe “the long struggle” NPs have had in Missouri with regards to not having FPA independently of physicians. But really, if you aren’t practicing advance practice nursing as you claim, but are in fact really practicing medicine, a discipline you haven’t been trained in, how can you practice independently in that discipline? Just saying. Just because other states do it doesn’t make it right. And the notion that FPA is needed as only NPs will go to rural areas has been debunked, and I have also written about this before (

But here’s more rhetoric in the article:

“Based on the models we’re seeing for COVID in Missouri, we will need additional personnel to assist at medical facilities, including the alternate care sites that we’re currently making ready,”

“Any state with full practice authority has dramatically better outcomes in terms of health care and mortality rates,”(no source cited)

“This year, the Association of Missouri Nurse Practitioners backed multiple pieces of proposed legislation that would reduce or remove barriers for APRNs,” (this is strawman for FPA)

            So, I believe in the role of nonphysician providers (NPs, PAs) serving in vital capacities on physician led multi-disciplinary healthcare teams. What I don’t agree with is using this pandemic crisis to advance a self-serving agenda: power and FPA. Missouri regulations still require physician collaboration, and this is a good thing. 

Just saying. 

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Robert Duprey MD

Robert is a 2nd career physician (MD); a combat Veteran with the US Army; a former psychiatric nurse practitioner; an independent researcher; a medical writer; and now having passed USMLE Steps 1, 2CK, 2CS, and 3, is a residency applicant.

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1 Response

  1. Steve O' says:

    This COVID-19 epidemic is merely part of a movement by the health industry, who use the nurse practitioners as a cat’s paw to get their way. Notice how many “specialties” are shut down – dermatology, rheumatology, gastroenterology? Do you really think that they will be funded to their previous “cost burden,” or will they be lightly staffed, with instruments and mid-levels, once the “epidemic” has shown that they are un-necessary and can be replaced by computers and gadgets? Ten years ago, I predicted that the “tele-visit” would become the norm – and voila! Of course, these confidential visits are scrutinized for accuracy in billing – as they are permanently recorded and saved as part of the medical record “for quality and privacy purposes.” So cheer on the over-burdened intensivists, and lay off the nurse practitioners (!) and physicians providing the “elective specialties” like cardiology. A rare opportunity for shaving off the burden of too many NP’s and MD/DO’s – and then licensure for the EMT’s to prescribe and treat when the “shortage” hits.

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