Here's an interesting statistic from the American Academy of Family Physicians: In areas where there are few physicians, there are still usually more doctors than nurse practitioners.
I was sent that stat and more after writing a blog post responding to the AAFP's and the American Medical Association's (PDF) insistence that in the drive toward team-based healthcare, physician leadership is an absolute requirement for any healthcare team.
While physicians have presented a unified front, they stand in isolation.
Nurse practitioners criticized the AAFP and called it "misdirected and out of step” on the issue. With a nod to the idea that the care-coordination-focused medical-home practice model is the new foundation of team-based care in the U.S., the NPs noted that none of the organizations that recognize practices as medical homes requires practices to be physician-led to earn the organization's seal of approval. (I had trouble believing that last part, so I called the National Committee for Quality Assurance, the Joint Commission and the Accreditation Association for Ambulatory Health Care, and they all confirmed it was true.)
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Predictably, the doctor-nurse scope-of-practice turf battle reignited after the American Academy of Family Physicians issued a report that said, essentially, nurse practitioners and other healthcare professionals play vital roles in team-based care that's provided under the patient-centered medical home practice model—but the team needs to be led by a physician.
The American Academy of Nurse Practitioners, in response, issued a statement declaring the AAFP to be "misdirected and out of step with today's environment."
The extra education physicians receive is at the heart of the debate, but Tamara Zurakowski, a practice associate professor at the University of Pennsylvania School of Nursing, said in response to the AANP's reaction: "A nuclear physicist knows a great deal more about the production of electrical energy than a licensed electrician does, but when I need the wiring in my house fixed, I don't hire a physicist."
Though it was the AAFP that fired the initial salvo—and then took the heat for doing so—it should be noted that the AAFP news release included words of support from the presidents of the American Academy of Pediatrics and the American Medical Association and the executive director of the American Osteopathic Organization.
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Although most public pronouncements from healthcare organizations these days sound like they're prepared from the same we're-all-in-this-together template, the latest scope-of-practice court fight showed that all sides still seem ready to drop the gloves at any moment.
A Colorado state appellate court affirmed a decision from the state's former governor permitting certified registered nurse anesthetists to administer anesthesia without a physician's supervision in the state's critical-access and rural hospitals.
Doctors then squared off against nurses and hospitals, and national organizations representing all sides joined in. The court acknowledged it was ruling narrowly on the issues of whether the governor had the authority to make his decision and whether the decision was consistent with state law. It said yes to both, but its opinion (PDF) also included this note:
"Our role is limited to determining whether Colorado law permits CRNAs to administer anesthesia without physician supervision. We may not pass on the wisdom of the decision to allow CRNAs to do so."
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