Nurse Practitioners Vs. Docs

(The Register Herald) Eleven years ago Tuesday, the worst foreign attack ever on American soil altered many lives forever, and one such changed life was that of Toni DiChiacchio.

An economist and certified public accountant for 15 years, she was inspired by the deadly assault known simply as “9/11.”

“I felt I needed to change something in my life to provide more to humanity, good things in the short life we have here,” DiChiacchio told Health Subcommittee A on the 11th anniversary of the terrorist attack.

“I went to nursing school and the rest is history.”

Now, she wants to help rewrite a law, removing what the West Virginia Nurses Association perceives as barriers that limit the role of nurse practitioners.

Nurses want to be autonomous, work devoid of a collaborative agreement with physicians, and exercise more freedom in prescribing medications.

In rebuttal, the new president of the West Virginia Medical Association, Dr. Hoyt Burdick, opposed the change.

DiChiacchio said she learned upon launching her business that 40 percent of all patients at Mon General Hospital in Morgantown lack a primary care provider.

Within a week after discharge, she told legislators, patients ideally would see a provider.

“That’s impossible to happen,” she said, noting discharged patients cannot get into a doctor’s office.

“Their schedules are too full,” she said.

“Some don’t take Medicaid. It’s a big problem out there. It’s only going to get worse. We need to do something about it now.”

As more doctors turn to specialties, such as radiology, she said primary care is a shrinking profession. Since 2006, citing the Harvard Business Review, there has been a 51 percent drop in family care physicians.

“One thing that could be done right now that would benefit West Virginians immediately is to lift statutory limits ion the scope of practice for advanced practitioner registered nurses,” she said.

One-third of the states and the nation’s capital have done so, she noted.

DiChiacchio said she found a doctor with whom to collaborate and was “shocked” that she was obligated to provide medical malpractice coverage.

“Despite the fact he never sees my patients, doesn’t touch them, doesn’t look them in the eyes, they don’t even know he exists — I pay twice the malpractice premium on him than I do myself,” she told the panel.

Four decades of research has failed to provide any evidence of harm to patients treated by nurse practitioners, she said.

“Often, nurse practitioner patients are more satisfied and often there is better control of chronic diseases like hypertension and diabetes, while under a nurse practitioner care,” DiChiacchio said.

“I don’t think that this necessarily has to be a turf battle.”

Burdick, who practices in Cabell County, disagreed, telling the legislative panel that the removal of collaborative agreements so nurses could work independently “isn’t necessary or beneficial, and is a step in the wrong direction.”

In fact, he said, the trend is for a teamwork in providing medical care, with the doctor in the lead, he said.

With possibly as many as 130,000 more West Virginians falling under Medicare and others enrolled in private insurance, the need is for providers — physicians and nurses — to work together, not independent of one another, Burdick said.

“The move for nurses to treat patients without a physician on the team comes at the same time the medical practice is changing to a team-based approach,” the doctor said.

“These two different approaches take the country and potentially this state in opposite and conflicting directions.”

Burdick agreed the nation has a shortage of doctors but said research projects a shortfall of some 260,000 nurses by 2025.

“This is even a more significant work force shortage than we’re facing with physicians,” he said.

In states that have ended the collaborative agreement, he said, there hasn’t been “any significant migration” of nurses to underserved areas.

Burdick said patients have shown they prefer a doctor to be involved in their treatment.

“What’s more, overwhelmingly, patients want a coordinated approach to health care, with a physician leading the team,” he said.

DiChiacchio told the committee she merely wants to improve health care in this state.

“I have no desire to practice medicine,” she said.

“I’m not a doctor. I want to provide health care.”

Burdick insisted there is no need to change the law.

“We have one of the more liberal collaborative agreements in the country,” he said.

“This is not a burdensome agreement. I don’t see it as a system that’s broken.”

Another effort will come next winter to reform the state law — a point not lost on the subcommittee’s co-chairman, Sen. Dan Foster, D-Kanawha.

“My hope is there’s a good agreement as to what needs to be done,” the Charleston surgeon said.