There has been much discussion and some movement on the issue of expansion of the "scope of practice" of nurse practitioners. While nurse practitioners are important to the health care team, simply giving full independence on the level of trained physicians may not result in improved patient care.

Non-physician caretakers, such as nurse practitioners, are a crucial component of our healthcare system. They are hard-working, dedicated, patient-centered individuals who are more than likely the first person a patient encounters. Together, the nurse practitioner and physician care for patients. The nurse practitioner typically obtains the information and creates a coherent list of a patient's presenting complaint, history and physical exam findings. Nurse practitioners work collaboratively with physicians for their patients, communicating information and findings, arming the physicians with the necessary information to allow him/her to put together accurate diagnoses. Such collaboration saves time for everyone involved. The physician considers the gathered information and generates a clinical picture from the various pieces, thereby making a diagnosis. That is not to say that a few nurse practitioners may exceed the clinical expertise of a few physicians. But physicians have a long head start due to their years of training and education. The clinical acumen that physicians acquire cannot be underestimated, nor discounted. 

To better understand the levels of training of various caretakers, including physicians and nurse practitioners, click here for a graphic depiction, originally published by the Florida Medical Association. Importantly, the very different types of training and lengths of education make physicians and nurse practitioners well-suited to work collaboratively. The vast importance of the medical school years, coupled with years of residency and standardized, extremely rigorous and challenging medical board exams has to be acknowledged and understood in this context. 

But what is also important to note is that the physician is the person who is primarily responsible, from a legal standpoint, for the patient's care. Expansion of the scope of practice of nurse practitioners, allowing them to practice independently, must also carry the same liability as physicians currently carry.

The Florida House (@MyFLHouse) recently agreed to expand the scope of practice of nurse pratitioners but, fortunately, the Florida Senate (@FLSenateGOP) did not. This mixed result has many people thinking that it is only a matter of time before the scope of practice expansion bill passes, allowing nurse practitioners to practice independently, without physician oversight and guidance.

Fortunately, there is an alternative plan that deserves much consideration. The Florida Medical Association has published the Five Pillars of Expanded Access, which addresses the shortage of physicians and access to care issues. It calls for increased collaboration between physician assistants, nurse practitioners and physicians. And it aims to regulate and codify telemedicine, an important developing component of health care in the 21st century. It is worth understanding this plan as the preferred alternative to unnecessarily expanding the scope of practice of nurse practitioners.

If you understand this issue as I do, and you live in Florida, please call your Representative and let them know that the solution to the physician shortage is not independently practicing non-physician caretakers. The solution to access to care issues is the Five Pillars plan promoted by the FMA. Please call your state Senator and thank them for not passing the bill and also impress upon them the importance of maintaining a firm stance against the expansion of the scope of practice of nurse practitioners. Ask them to keep the valuable and long-standing cooperative structure in place, allowing nurse practitioners and physicians to continue to work together for the safety and health of all patients.

Patients depend on their caretakers to give them the best care possible. The highest level of expertise must remain clearly spelled out in the laws so that people everywhere can continue to have confidence in the medical profession.