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Nurse Practitioners Need Physician Supervision

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By ALLEN FINKELSTEIN

Published: November 21, 2007

I have some serious concerns about the ARNP (nurse practitioner) push for controlled prescriptive privileges. This push is consistent with a nationwide effort for the Advanced Registered Nurse Practitioner to be fully independent from the supervision of licensed physicians. Physicians in Florida, including myself, are deeply concerned about this issue. As a doctor, I am ultimately concerned about the well being of my patients.

While the healthcare access crisis is definitely an issue in Florida, I do not believe unsupervised non-physician practitioners are the answer to that crisis. ARNPs, like Physician Assistants (PAs), most definitely play an important role in the healthcare system to improve access, but that role should not be one of practicing medicine independently.

The healthcare access crisis can be remedied by a strong healthcare team, such as a Physician-PA team or a Physician-ARNP team, which allows for plenty of access opportunities with patients while keeping patient safety a top priority. When properly supervised, a PA or ARNP can complement the office or practice of a physician for the better. When completely unsupervised, the gap in training and education of a practitioner without a physician's availability for guidance could be a recipe for disaster.

Most recently, the use of "Little Clinics" that are only manned by unsupervised nurse practitioners is a trend creating concern among much of the physician community. Recent findings suggest these ARNPs may not even have collaborating physicians within their own state. Any practitioners or retail businesses circumventing state law to practice medicine independently without Florida physician collaboration is a dangerous practice that the community should be concerned about.

So while I understand Anna Small's concern about the physician shortage and patient access (Other Views, Nov. 15), I would like her and the Florida Nurses Association to recognize that there is a place for all of our medical professions to work together to alleviate this crisis without granting doctor-like status to those who haven't actually walked the path of physician training. And those who want to practice medicine independently should return to medical school and become physicians.

Allen Finkelstein is a physician in family practice.

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