Every few years, New Jersey faces the monumental question of whether to expand a professional group’s scope of practice. This year, advanced practice nurses (APNs) lead the charge.
At the onset of the pandemic, Gov. Phil Murphy issued executive order No. 112 permitting APNs to practice without any physician involvement or consultation. This well-intentioned order was a crisis response, allowing APNs to respond to patient needs as the number of infected New Jersey residents overwhelmed our hospitals.
Now, as we enter the post-pandemic era, pending legislation would make permanent the governor’s three-year-old order. Senate bill S-1522 would allow APNs to practice across all specialties without necessary physician involvement, effectively removing physicians from care teams statewide and dismantling New Jersey’s traditional APN care-delivery model.
Some claim S-1522 would not change much, aside from allowing APNs to see patients without the need for physician collaboration. But two recent studies tell a different story. A study from Stanford University and another study from one of the largest clinics in Mississippi, show that APNs practicing without physician guidance actually increases costs for patients and the whole system, despite their lower salaries. According to the results of the studies, because APNs have less training than physicians, they tend to overprescribe medications, make unnecessary referrals and order unnecessary tests and diagnostic imaging studies.
Patients care about experience and expertise when it comes to their health care:
- To the patient who takes five different drugs for five related but separate medical conditions, having a physician-led care team matters. This patient needs a physician’s underlying scientific and clinical knowledge about how drugs interrelate and effect multiple body systems.
- To the mother whose child is undergoing routine surgery, physician-led care matters. She wants to know her child’s general anesthesia is overseen by a physician, not an APN, who can act within seconds if something goes wrong.
- To the young man who is dealing with a less-than-obvious condition, physician-led care matters — especially when he is diagnosed only because his physician had extensive training and experience.
If S-1522 were to pass, APNs — who have completed college and a two-year graduate nursing degree — would be eligible to practice without any physician oversight. In fact, an APN with just two years of experience could possibly oversee another APN fresh out of school. Even the best and brightest senior medical residents — who complete four years of intensive undergraduate pre-medical education, four years of medical school and are finishing up three to seven years of residency training — still practice under attending physician guidance, and there’s good reason for that. Even the process of initial diagnosis often becomes one of the hardest, most nuanced part of medical care, especially when even the average patient can present with many variables that must be identified and assessed. This requires the combined education, training and then the first-hand experience only a physician can offer.
All New Jersey residents are entitled to the best possible care from a team of trained, educated and experienced professionals, who should be led by a physician. Rather than dismantle that team, we should be strengthening intra-team connections so that our patients benefit. That is why meaningful collaboration, especially between physicians and APNs, is so critically important.
There’s nothing wrong with scope expansions when they’re done right. As president of the state’s Board of Medical Examiners in the mid-1990s, I supported the creation of the New Jersey physician assistant license. But doing this right means keeping the physician at the head of the care team, ensuring patients are getting not just care, but the best appropriate care possible. Our goal cannot be to sacrifice quality just so more clinicians can practice alone: quantity of care should never replace quality of care, no matter the specialty or circumstance. Contact your state legislators today. Tell them physicians are an essential part of your health care team and that you refuse to settle for anything less.