Dr. Lawrence John: Patients want physicians involved in their health care | TribLIVE.com
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Dr. Lawrence John: Patients want physicians involved in their health care


Nurse practitioners have been pushing state lawmakers to remove their collaborative agreements with physicians in Pennsylvania for a number of years. But a new public opinion poll should give state lawmakers in Allegheny County pause, as the vast majority of participants indicated they would not support such a move.

Susquehanna Polling and Research Inc. polled 300 registered voters in Allegheny County in September and found that 70% want physicians and nurse practitioners working together through a collaborative agreement. Only 19% said it was OK to allow nurse practitioners to practice independent of physician collaboration.

Allegheny was one of 11 Pennsylvania counties polled throughout the commonwealth. Results were similar regardless of size. For example, 75% of participants in Potter County — the smallest county polled in terms of population — said they, too, wanted to keep collaborative agreements.

The fact that rural Pennsylvanians want physicians involved in their care as much as city residents undercuts arguments that freeing nurse practitioners from collaborative agreements would enhance care in less populated areas.

The question we should be asking is how can Pennsylvania increase access to care in underserved areas without sacrificing quality? Nurse practitioners play an important role, but we’re all better off when physicians are involved as well.

In the Allegheny County poll (which was funded by the Pennsylvania Medical Society, Pennsylvania Osteopathic Medical Association and Pennsylvania Academy of Family Physicians), by a 34% to 20% margin, respondents said allowing nurse practitioners to practice without physician collaboration will have a negative impact on the quality of care. And 86% cited physicians as most trusted to deal with chronic illnesses.

Under Pennsylvania law, nurse practitioners are already free to diagnose, establish treatment plans, order diagnostic imaging studies and other tests, and prescribe almost all of the same medications that physicians prescribe. A collaborative agreement with a physician is not a burden, but an assurance that deeper medical expertise is immediately available in the care of patients.

The Pennsylvania Medical Society and other groups that oppose legislative measures to remove collaborative agreements say there are better ways to provide high quality care in areas that lack enough health care professionals.

One way is to pass pending legislation that expands telemedicine services. Another is to increase funding for student loan repayment programs for all health care professionals who commit to working in rural and underserved areas. That would encourage both physicians and nurses to serve in rural areas.

Pennsylvania’s population is one of the oldest in the nation. As we age, the complexity of illness requires a health care professional who possesses the clinical acumen to appropriately and effectively treat patients who often present multiple and complex conditions. Physicians are the most capable professionals to meet the needs of patients with complex conditions. Their training is both longer and more in-depth than nurse practitioners.

We should be developing policies that encourage the next generation of health care professionals to attend medical school. Removing nurse practitioners from collaborative agreements may have the unintended consequence of disincentivizing our best and brightest from becoming physicians.

Lawrence John, M.D., is president of the Pennsylvania Medical Society and a family physician from Aspinwall.

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