When a friend or loved one requires an expert medical opinion or emergency care, those involved hope to receive the highest quality health care from the most qualified health care professionals. In these stressful times, we rely on medical experts to guide us down the best path. However, there’s a current debate in Trenton over a central issue during those situations.
Which healthcare professional should determine and oversee a patient’s diagnosis, treatment plan and weigh in with their expertise?
The debate centers around legislation (S-1522/A-2286), which would codify into law Executive Order 112. the order allows advanced practice nurses (APNs) and certified registered nurse anesthetists (CRNAs) to provide care, prescribe treatment and administer anesthesia without any physician involvement or consultation.
The executive order issued by Gov. Phil Murphy three years ago was a well-intentioned, temporary crisis response to COVID-19 when hospitals were overwhelmed and the system needed all hands on deck. However, it has become abundantly clear to many — including 18 medical organizations representing 31,000 physicians from around the state — that the executive order has outlived its purpose and this emergency waiver should be rescinded.
There has been plenty of misinformation and distortion surrounding this issue from those who believe APNs should provide care for patients without physician involvement through collaboration and supervision. Here are some of the myths perpetuated on this critical topic.
Myth #1: Mandatory collaboration isn’t needed to keep patients safe.
This assertion directly contradicts multiple high-quality studieson physician-led, team-based healthcare, which show APN quality of care does not match that of physicians. Physicians must adhere to a higher standard of evaluation and spend more time training in patient evaluation and treatment. They inherently have deeper experience and are better prepared to manage patient care than non-physician practitioners. Bottomline, allowing APNs to practice across all specialties without essential physician involvement poses a risk to patients in our state.
Myth #2: Loosening restrictions boosts productivity and lowers costs.
Without a physician’s involvement, patients are more likely to be misdiagnosed and given excessive and inappropriate testing, prescriptions and treatment. In an emergency room department, we know from 3 years of data from the Veterans Health Administration, that patients experience worse clinical outcomes with a net increase in medical costs when there’s no physician oversight. This is a direct result of the significant differences in the education and training of APNs and physicians on how to make differential diagnoses.
Myth #3: Patients already see APNs without physician involvement.
Another common misconception is that physicians aren’t involved in a patient’s care even when they are working in the same practice with an APN. In truth, there is always physician consulting, checking charts, and viewing a patient’s diagnosis and prognosis. This applies in practices, emergency departments, hospital settings — as with anesthetists during surgeries — and other areas.
Myth #4 Mandating collaboration is burdensome and meaningless because of APNs’ training, education, and experience.
APNs are an essential part of the success of our health care system, but they offer patients a different skill level and don’t have the full scope and depth of training offered by physicians. Physicians are required to have 10,000-16,000 hours of clinical experience and between 7-12 years of preparation for practice. Medical school graduates cannot even practice without supervision for another 3-7 years after medical school. APNs spend far less time learning, often completing only 1,000 to 2,000 clinical hours and a two-year graduate nursing degree.
Myth #5: APNs practicing independently will address physician workforce shortages.
This assertion does not match the reality playing out across the state. APNs have pushed beyond the intent of the executive order and opened practices in multiple specialties without patient protection and physician collaboration. They’re also entering into specialties in nontraditional APN healthcare settings, such as:
- Aesthetic/ cosmetic practices working with Botox and invasive laser treatments
- Launching medical weight loss and pain management practices
- Setting up medical spas
We owe APNs a tremendous debt of gratitude for all their contributions, value, and courage, especially during the pandemic. However, removing physicians from care teams isn’t the right way to show this appreciation, and many in New Jersey agree. According to a recent poll, an overwhelming majority say they want the most skilled practitioners available — physicians — to oversee their healthcare.
Allowing APNs to practice without a physician across all specialties is not in our state’s best interest and would remove the gold standard of care that patients deserve: a physician-led, team-based model of care. We must keep the health care teams intact and oppose S-1522, a bill that would be a disservice to patients and families across the state.
Lawrence Downs is the CEO of the Medical Society of New Jersey.