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Dr. Gene Battistella: Pending bills could impact patient care in Pa.

October 5, 2018

As an osteopathic physician who has been practicing in Pittsburgh for over 20 years, I have learned that there is no magic prescription that can relieve a patient’s pain or provide complete relief from an ailment.

In fact, the foundation for osteopathic medicine rests in the comprehensive evaluation and treatment of the whole patient -- not just a symptom. This holistic approach is based on an understanding and knowledge of our patients, their families and their lifestyles.

It takes time, dedication and years of education and experience to be able to develop a treatment plan that is individualized for each patient. There are no shortcuts or quick fixes when it comes to practicing sound, effective medicine.

Unfortunately, some lawmakers in Harrisburg appear to be looking for a shortcut as they debate bills that would have a dramatic impact on the practice of medicine in Pennsylvania. These bills would expand the scope of practice for physician assistants (PAs) and certified registered nurse practitioners (CRNPs) -- without requiring any of the additional education or training that is required for physicians.

All Pennsylvanians should be concerned because, ultimately, these bills could jeopardize patient quality care and worsen the state’s opioid crisis.

House Bill 100 and Senate Bill 25 would permit CRNPs to practice medicine without physician supervision by eliminating the collaborative practice agreement after three years of physician supervision. CRNPs would have the authority to prescribe drugs, including controlled substances, without any direction or guidance from a physician. In addition, CRNPs would act as primary care providers under state health insurance plans.

CRNPs provide a valuable service and are a key part of our health care team. However, lawmakers must take into consideration the vast difference in education and training for physicians and nurses.

Doctors of osteopathic medicine receive 12,000 to 16,000 hours of supervised postgraduate medical education during internship and residency. This follows vigorous undergraduate and medical school education. Nurse practitioners receive 750 hours of lecture and practice/learning hours during their training.

The training itself is also vastly different. For example, patients often present with symptoms that could have multiple causes and in widely differing clinical scenarios. Osteopathic physicians are trained to examine multiple possibilities, reach a final diagnosis and map out a treatment plan.

We were taught this throughout medical school, internship and residency programs.

This is a critical difference that lawmakers cannot ignore. In medical school, I learned how to study and think like a doctor. This process continued through all my years of training and continues to this day. Simply put, I didn’t know what I didn’t know until I put my book smarts into practical use.

I cannot stress enough how valuable CRNPs and PAs are as members of our team. However, they do not bring this same level of education or training to the table. Ultimately, I believe key medical decisions should be made by a physician licensed to practice in medicine in our commonwealth, as the best leader of this team.

Lawmakers also need to consider the impact these proposals could have on the state’s opioid crisis. Osteopathic physicians have added training in the use of manipulative therapy, or hands-on treatment.This approach can be a much safer option than prescription painkillers for some, though certainly not all, patients.

Opioid prescribing in Pennsylvania has dropped significantly, 22 percent from 2013 to 2017, under the current state law which requires the collaborative practice of CRNPs and PAs, again under the supervision of a licensed physician. Unsupervised prescribing, which is allowed under this new legislation, could potentially reverse this gain and place our patients at risk .

I am not suggesting that osteopathic medicine offers the only solution to ensuring access to high quality care. However, I urge lawmakers to take a step back and consider the unintended consequences that these proposals would have on their constituents and all residents, families, friends and patients in Pennsylvania.

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