We are still experiencing some of the fallout from the recent VA and military hospital scandals (see: Why the Military and the VA Healthcare Systems Are Not Amenable to Change; The Challenge of Quality Lapses in Military Hospitals; Here's One Possible Solution). The most recent news is that that the U.S. Senate is considering a bill to allow nurse practitioners employed by the VA system to treat patients independently including prescription writing (see: VA nurse practitioners could practice independently under Senate bill). Below is an excerpt from the article:
Senate legislation is looking to empower nurse practitioners across the Veterans Affairs Department to practice independently of physicians, regardless of laws in individual states. The goal is to mitigate physician shortages and reduce patient wait times that have been plaguing the VA. The provision would allow nurse practitioners—including midwives and mental healthcare clinical nurse specialists—to prescribe some drugs and treat patients without a supervising physician. Maryland last month became the 21st state to allow nurse practitioners these privileges. The remaining states require them to have a collaborative agreement with a physician.....Complaints of long wait times at VA hospitals and outpatient clinics across the U.S. and an attempted cover-up led to the resignation of VA Secretary Eric Shinseki and prompted lawmakers to pass VA healthcare reforms, including relaxing a rule that allowed veterans to get private care paid for by the government....The Senate bill would also expand a pilot program where “intermediate-care technicians” practicing within the Defense Department would get priority placement at VA healthcare facilities that have the longest wait times....A bill before the House also aims at addressing personnel shortages. That bill would allow certified registered nurse anesthetists to practice independently.
I have posted previous notes endorsing the idea of enabling nurse practitioners (NPs) to operate more independently (see: A Solution to the PCP Shortage: Nurse Practitioners; Future key Role of Nurse Practitioners in Primary Care). Part of my reason for supporting this change is that they could serve as a partial substitute for primary care physicians (PCPs) who are in short supply in some parts of the country. It is understood that NPs should not be placed in clinical settings where the practice requirements exceed their ability to deliver high quality care.
Much of the pressure not to allow NPs to practice independently has come from organized medicine. It's no surprise that the federal and state governments are willing to expand the roles of NPs. The federal government is trying to improve healthcare delivery in the VA system after all of the recent bad press. It may be difficult to recruit physicians for the system. State governments are also anxious to improve healthcare delivery in rural areas. It will probably be easier to recruit NPs for these settings than physicians, particularly if the personnel are raised in the area. One gets the impression that the lobbying power of organized medicine is decreasing in the face of some of the quality and access problems we are seeing. Here's a link to a web site that claims that the AMA spent $2,072,441 in political contributions in the 2014 election cycle, ranking only 131 of 16,875 organizations reviewed.