Doctors fight efforts by nurse practitioners to work independently and fill gaps in primary care

( Doctors and nurse practitioners are sparring over who will provide basic primary care to the 30 million U.S. citizens expected to get health insurance under the federal Affordable Care Act, also known as “Obamacare.”

Nurse practitioners say they can do their jobs just fine without doctors and they’re lobbying lawmakers to end restrictions in more than a dozen of the 34 states like New York that require physician oversight, according to a story by Bloomberg. Despite the need for increased care, doctors are pushing back, fighting for restrictions with their own lobbying efforts as well as with lawsuits across the country, arguing that patients’ basic care is at risk.

In New York, nurse practitioners are pushing for proposed legislation that would allow them to operate without collaborating with a doctor.

The showdown comes at a time when the U.S. faces a shortage of more than 13,000 doctors, a gap expected to grow to 130,000 by 2025, according to the Association of American Medical Colleges. New York is short about 12,000 doctors.

Doctors’ groups, led by the American Medical Association, say they are ready to fight those efforts and warn the changes could endanger patients and further fragment the health-care system. Removing doctor oversight of nurse practitioners “would seriously endanger the patients for whom they care,” Elizabeth Dears, a senior vice president for the Medical Society of the State of New York, an advocacy group for New York doctors, said in testimony to lawmakers. In New York, the governor’s proposed budget would allow the health department to remove the need for a written collaboration between a doctor and nurse practitioner for primary care.

During a recent talk in Syracuse, Dr. Nirav Shah, the state’s health commissioner, chided fellow doctors for fighting efforts by nurse practitioners to work more independently.

“Doctors need to stop drinking the Kool Aid of 20 years ago and start understanding the new world we live in,” Shah said. “There are a lot of doctors who don’t want to change. They want to do business as usual and they are not ready for the new world order.”