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Ohio bill would give advance practice registered nurses independence from doctors

August 30, 2018

Ohio bill would give advance practice registered nurses independence from doctors

COLUMBUS, Ohio – A new Ohio General Assembly bill would allow advanced practice registered nurses to work independently of physicians, an idea the Ohio State Medical Association calls potentially dangerous to patients.

Rep. Theresa Gavarone, a Bowling Green Republican, said House Bill 726 addresses primary care physician shortages throughout the state. But the medical association disputes there are shortages.

Advanced practice registered nurses, called APRNs, diagnose and treat diseases and can prescribe medicine. 

APRNs must enter mandatory collaboration agreements with doctors under Ohio law, said Jesse McClain, president of the Ohio Association of Advanced Nurse Practitioners -- which supports the bill. 

McClain in a statement described the agreements as “little more than a fee APRNs pay to a physician in order to practice. Far from collaboration, this contract requires APRNs to provide a subset of their charts to physicians for review, while no actual collaboration regarding patient care occurs between the contracted physicians and APRNs.”

Over 20 U.S. states and the Veterans Administration allow APRNs to practice independently of doctors, Gavarone said. She would like Ohio to be another state that gives more independence to the nurses.

The medical association, on the other hand, argues that physicians undergo expensive, intensive training to understand the human body. APRNs provide a valuable service, but physicians need to lead medical teams because of their extensive knowledge, said Reggie Fields, a spokesman for the medical association.

A similar bill to HB 726 was introduced during the 2015-2016 Ohio legislative session.

Fields said the medical association worked with lawmakers to amend the bill, removing the provision that APRNs work independently in exchange for some changes to how the nurses practice – including removing a 15-hour externship requirement that had been necessary before they could have prescribing authority.

Fields said it’s disappointing that the bill is back.

“The elected leaders agreed that physicians should remain at the head of the medical team providing care for patients in the state of Ohio,” he said.

Gavarone and Fields both use data from the Association of American Medical Colleges to make a case that there are enough -- or not enough -- doctors in Ohio.

Fields pointed to last year’s study that showed Ohio has 93.9 primary care physicians per 100,000 people. The national average was 90.8 physicians. Ohio also has more younger physicians compared to other states: The state has the sixth lowest percentage of doctors over age 60 – at 27.5 percent. Nationally, the average is 30.3 percent.

Gavarone pointed to a Plain Dealer report showing that there has been a steadily increasing doctor shortage across the nation – with Cleveland Clinic, MetroHealth System and University Hospitals saying they needed primary and specialty care doctors. The state is aging, which means more demand for doctors. 

Her district spans all of Wood County, population 130,000.

“You’d be surprised to know how far of a drive it is in certain parts of the county to see a primary care physician -- much less a specialist,” she said.

Access to care is a priority to Gavarone, who also is sponsoring a bill that would allow psychologists to obtain a master’s degree is psychopharmacology, undergo training and supervision and be able to prescribe psychotropic medicine to patients. She said she’s concerned about mental health and other places, such as Illinois and all branches of the U.S. military, permit it.

The medical association also opposes that bill, saying people with Ph.Ds in psychology – even with the extra training – don’t understand how drugs interact in the body with other drugs and medical conditions outside the scope of mental health.

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