False Promise Of Accesscould Jeopardize Safety
While we share The Times-Tribune’s goal of improving access to care in rural and underserved areas, the Pennsylvania Medical Society vigorously disagrees with the solution posed by the editorial board April 19 (“Nurse practitioners should have expanded access”). The Times-Tribune supported state legislation (Senate Bill 25) that eliminates the requirement that certified registered nurse practitioners have a collaborative agreement with physicians. One of the Times-Tribune’s reasons — that it would incentivize more CRNPs to move to rural areas to fill a growing physician shortage — isn’t supported by the facts. If collaborative agreements impede CRNPs from moving to rural areas, as supporters of Senate Bill 25 seem to suggest, why are states that don’t require collaborative agreements with CRNPs still struggling to tackle access-to-care issues? For example, Arizona has not required CRNPs to have collaborative agreements since 2001, yet only 11 percent of all non-physicians (CRNPs, physician assistants, certified nurse midwives) work in rural areas and serve only 15 percent of Arizona’s rural population. So removing the collaborative agreement requirement for CRNPs in Arizona hasn’t worked. In contrast, Pennsylvania already has a higher number of CRNPs working in the state’s 10 least populated counties compared to Arizona, West Virginia, Maryland, and New Mexico — all states in which CRNPs do not need a collaborative agreement with physicians. According to the American Medical Association’s Workforce Map, there are 1,401 people for every CRNP in Pennsylvania’s 10 least populated counties. By comparison, West Virginia has 1,817 people for every CRNP, Arizona has 1,807, Maryland 1,454, and New Mexico 1,434. As a physician who lives and practices in rural Pennsylvania, I agree that more needs to be done to address a lack of health care professionals in rural and underserved areas. However, legislating medical degrees is not the answer. If lawmakers truly want to address this issue, more effective measures would include: ■ Supporting current legislation that expands telemedicine services. ■ Increasing state funding for physician residency programs. ■ Increasing state funding for existing loan repayment programs for all health care professionals who serve in rural and underserved areas. ■ Removing existing barriers for international medical graduates to obtain their medical license in the same number of years as their American-born physician counterparts. ■ Providing civil immunity to those willing to volunteer at local health clinics. CRNPs are an important part of the health care team and can diagnose, establish treatment plans, order diagnostic imaging and other tests, and prescribe almost all of the same medications that physicians prescribe. A collaborative agreement with a physician serves to ensure deeper medical expertise is immediately available, especially for complex cases. Senate Bill 25 calls for CRNPs to work without a collaborative agreement after only 3,600 hours of experience — that’s coupled with about 500-750 hours of education and training. Compare that to the 12,000 to 16,000 hours of education and training that physicians need to practice independently. In addition to the amount of education, you also need to examine the quality of clinical training CRNPs receive. Whereas medical schools have a rigorous standardized curriculum that often requires students to spend 60-80 hours per week to master, some doctor of nursing programs are 100 percent online. The immense benefit of “hands-on” training cannot be replaced through online learning. Pennsylvanians in rural and underserved areas deserve equal access to care, which involves physicians and CRNPs working together. If severing the collaborative agreement won’t improve access to care, as data from other states indicate, why should Pennsylvania lawmakers split us up?