The health care industry is undeniably going through a transformative period in terms of advancements, one that could lead to countless lives saved and health maintained. But one element of this transformation threatens to roll back much of the progress we’ve already made, permanently changing for millions of New Jersey patients which health care professional can oversee their diagnosis and treatment, and how much experience and training is required for those making critical care decisions for you and your family.
This debate surrounds pending legislation (Senate Bill 1522/Assembly Bill 2286). This bill would codify into law a COVID-era executive order (Executive Order 112) that allows advanced practice nurses and certified registered nurse anesthetists to provide care, prescribe treatment, and administer anesthesia without any physician involvement or consultation whatsoever.
That order was issued by Gov. Phil Murphy in response to the pandemic, when hospitals were overwhelmed and staffing shortages affected nearly every facility. However, it’s become abundantly clear to many – including 18 medical organizations representing 31,000 physicians across the state – that the order has outlived its purpose and the emergency waiver should be rescinded. Allowing APNs to practice without essential physician involvement poses a risk to patients in our state.
As with so many debates in our current public discourse, this one has been hijacked by those spouting misinformation and distortion. But the studies are clear and the numbers, like these from Stanford University analysis, simply don’t lie: patients get lower-quality care from only an APN compared to APNs working in physician-led team. Collaboration with a physician directly leads to enhanced patient safety and better outcomes.
Even arguments about increasing provider access to care cut against allowing APNs to run independent practices: allowing APNs to practice without physician involvement would not increase the number of providers caring for New Jersey patients. Its only effect: taking integrated teams and breaking them up, creating new silos, despite the universal recognition that siloed care is lower quality care and higher cost care.
Similarly, APN independent practice would not improve access for those who need it most. Studies show that although 84% of APNs study primary care, only 55% end up working in a primary care practice, choosing more lucrative specialties. They also typically cluster in higher income areas and go into specialty practices where they can make the most money.
You’ll also hear arguments that APNs already do almost everything a doctor does. This is both false and dangerous. Physicians must adhere to a higher standard of evaluation and care, and they spend thousands more hours than APNs in training in medicine to be able to do so. They have deeper experience and are better prepared to manage patient care for all but the healthiest (preventative care) patients.
Advocates of extending the order argue that allowing APN’s to practice without physician involvement will reduce costs and alleviate emergency room strain. Yet just the opposite is true. The Stanford study showed that independent APN practice increases costs of care by 7% and leads to 11% longer stays in emergency rooms.
As with all health care workers, we owe APNs a tremendous debt of gratitude for 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 health care.
Allowing APNs to practice without physician involvement – even across specialties like anesthesia – is not in our state’s best interest and would remove the gold standard of care patients deserve: physician-led, team-based care. We must keep the health care teams intact and oppose S1522/A2286, a bill that would be a disservice for patients and families across the state.
Joshua Bengal is the director of government relations & staff counsel, Medical Society of New Jersey.