From 2016 to 2017, nurse practitioner (NP) certificates issued in the U.S. doubled. This rapid production was sparked by the Academy of Medicine’s idea to expand the scope of practice for non-physicians to as an answer to the physician shortage. The authors of the Affordable Care Act took this advice and carved out a section of legislation to push states to give NPs lawful rights to practice without the collaboration or supervision of physicians. With this green light, the American Association of Nurse Practitioners has successfully lobbied 23 states, the District of Columbia, and the VA to essentially allow NPs to practice medicine (that is, examine, diagnose, and treat) without a medical license. Organized think tanks supporting this idea equating NPs with physicians, fund campaigns and shape policies of both Republican and Democratic lawmakers. These policies have lead to NPs saturating markets in urgent care clinics, emergency departments, ambulatory clinics, and hospitals. Large Pharmacy Benefit Managers, like CVS Caremark, have seized the moment and created instant medical care centers staffed mainly by NPs.
It is arguable whether or not this has improved patient access to medical care services. However, what is most concerning is whether some patients actually have a choice in who they see when they seek medical care. As a member and president of the grassroots physician group PHYSICIANS FOR PATIENTS, I see and hear a growing number of stories where patients show up to or call for an appointment with a physician and are told they must see the NP or PA (Physician Assistant) first. Some patients say they are told the NP or PA is the same as a medical doctor. In some instances patients may not even get to see a physician during the visit. I also have physician colleagues telling me they refer a patient to a specific sub-specialist and their patient is forced to see a non-physician. Essentially, the patients are being told they don’t have a choice in their own medical care. But, patients should know they do have the right to choose the type of medical care personnel they see. There are several laws and statutes to protect patients’ rights to choose. Do you know them?Tweet