The American Medical Association Doesn’t Want You to Read This

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They say a blog is like a shark – feed it or it dies. I want to explain why the frequency of my posts has declined. Unlike many blogs, the posts I write are not about things that happened 15 minutes ago. While at times I write opinion posts (admittedly more so in recent months), what I really would rather be doing is sharing interesting ideas, research and information that will help you take the best possible care of yourself.

But just because I’m not here as often doesn’t mean there’s not a lot already on the site for you to keep coming back to read. (I know exactly how long visitors spend on the site, gentle readers, and you have not read most of what is already here.) I am confident there is useful information on this site that you have not yet explored. This post explains the issues that are keeping me from writing more blog posts these days.

Health Reform is Passed and Signed into Law

On March 23, 2010 President Obama signed health care reform into law. That stroke of a pen changed everything about health care for everyone – nurse practitioners included. NPs have been functioning in almost every corner of the health care system for more than four decades and many, like me, are primary care providers.

Because of health care reform there is a tsunami of patients headed for a health care system that does not have enough primary care providers to take care of them. Yet in spite of that the AMA (American Medical Association) in this linked document (which they did not release to the public) along with some other physician organizations continue to oppose giving NPs the full practice and prescriptive authority we need. As an NP in primary care, I face crippling practice restrictions everyday that make delivering quality care both inefficient and more costly than it needs to be.

One NP’s Story

Let me tell you my story and you decide whether the AMA’s position is meant to serve you or is serving only the AMA. And please, don’t take my word for it, read the links below for other opinions and studies on the safety of NP practice.

In my case, I share a busy internal medicine practice in Naples, Florida with a single physician. We work in our practice like any two doctors would (though I am an NP). But rather than each having our own separate patients we both see everyone in the practice – patients go back and forth between us depending on our schedules and their preferences. We don’t divide the patients up by “easy” or “hard”. And whenever one of us takes time off the other one covers the whole practice.

We work this way because, as an NP, I have experience and expertise the physician does not – because she’s not a nurse. As a physician, she has experience and expertise I do not – because I’m not a doctor. But 90% of what we both do is exactly the same – whether she does it or I do it we are providing the same care. And because we come from different disciplines, by practicing in this way, we can deliver a broader spectrum of care that either one of us would be able to deliver by ourselves.

This physician does not, nor has she ever, “supervised” me. I have been practicing medicine and nursing in this way for over 15 years. I’m not sure I would have ever landed any job I’ve ever held (except, perhaps, my first one right out of grad school) if I required “the watchful eye” of a physician to oversee the care I provide. Physicians are far too busy themselves to “supervise” other providers. The position the AMA and others have taken with regard to NP autonomy is about control and money only – not your safety. NPs’ quality of care has been proven over and over (and they know it). See the links at the end of this post to see for yourself.

Support NPs

So what does all that have to do with a blog being like a shark? Nothing really, except I don’t want the blog to die because I can’t feed it as often as I would like. I hope the health care wars will end soon so I can come home to the blog for good. In the meantime I am out there speaking and writing. I am working for the legislative reform of draconian laws that are limiting your access to care. Until the impediments that keep NPs from doing what we are trained to do are lifted, the best I can do is send in posts from the front lines. This is one of them.

Please support NPs. Write your elected officials, write the newspapers, post comments on websites (even this one) about your experience with NPs. Stand up for NPs. We have always fought for you and are fighting for you now – but we can not do it alone.

Thanks for being here.

Related Links:

The New Doctors in the House

Do physicians deliver better care than Advanced Practice Registered Nurses?

The effect of Evercare on hospital use.

This information is offered for educational purposes only and is not intended to diagnose, prescribe or treat. For that please seek direct care from a health professional.

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3 comments so far. (Post your own)

#1 | On January 10, 2011, jen said:

well said. Please keep blogging because even if you think infrequent many of us repost you elsewhere. There are many who get up each day and think, i cannot do this battle one more day. They need to hear about your practice, my practice (like yours although she is a he and so enamored with the refreshing support I married him), but we have changed institutional rules, set the bar and do so every day.
My message is, if they cannot, then leave. So many can and will support and perpetuate what you can do, not to feed your ego but to allow access to the care you can provide, unrestricted, to many. They are the people who need you to battle one more day, blog one more day. We know that for us it is not about the money or the turf, but the people. Our people, as those who know me could quote me, they are the teachers of my kids, the coaches of my sports, the leaders of my community. They need me. And if the physician by my side cannot see that then he does not deserve me. It is already so, the train already left, I have nothing to defend, I have only the work I do, and i will do it.
“Promise me you’ll always remember: You’re braver than you believe, and stronger than you seem, and smarter than you think.“ Whinnie the Pooh
Jen

#2 | On March 01, 2011, Fred L Von Gunten,O.D.,F.A.A.O. said:

This reminds of the “older” days when I practiced Optometry ( 1966-1999). Ophthalmology was always thought of as the primary eye care profession. However,by 1984 most states approved Optometrist for Diagnostic Pharmaceutical Agents (DPA)  and Therapeutic Pharmaceutical agents (TPA). The Optometrist soon became the primary eye care provider. A lot of Optometrist now work as equal Optometric Physicians with Ophthalmologist. This has been a long battle legislatively, and now the public can be assured that their eye care is provided with the finest care in mind.

Carla, Your training and years of expertise qualify you at the same level of a physician’s expertise. I know, for I’m a steady patient through you office. An every time I leave,I know you have given me the best of Health Care.

Blogs are important…but you can feed it when you have an impressive topic to discuss.

Dr Fred

#3 | On March 03, 2011, Carla Mills said:

Dr. Fred,

Thank you for your comments. Your comparison of the evolution of optometry to NPs’ evolution is a very good one, I think, and adds perspective to this discussion.

As you are my patient, your expression of confidence in my clinical abilities and experience means more to me than I can say. My patients and their well being are the yardsticks by which I measure the quality of my practice - not the criticisms of those who seek to undermine the value of my practice strictly for political and financial reasons. Thank you very much for your support!

Carla

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