A pending bill in Pennsylvania, SB 25, would allow nurse practitioners to have independent scope of practice, that is, one free of physician supervision, after a three-year, 3,600 hour collaboration with a physician.
The legislation has generated opposition from doctors (shocking!) in the Commonwealth. In an opinion piece for The Intelligencer, Dr. Mark Lopatin raises his objections:
Basically, SB25 allows those without medical training [not at all true], a medical degree or medical licensure [technically true] to practice medicine. NPs would not be practicing nursing, they would be practicing medicine. This bill sends the message that one does not need to go to medical school to practice medicine and promotes an acceptable alternative pathway which is a shortcut. With all the talk today about how important health care is, is that the message we want to send to patients?…
I have heard it stated by some that NPs can do 85 percent of what a doctor does. Let’s go one better and assume 90 percent. If we assume ~ 25 to 27 patients per day, that means that two to three patients will receive lesser care each day. That is 10 to 15 patients per week and more than 500 per year per NP. Is that an acceptable miss rate?
Milton Friedman compared licensing boards to medieval guilds, but mathematics was advanced enough in the 13th century to refute his argument. If NPs can do 85% of what doctors can do, that simply refers to the scope of their practice (in the practical sense, not the legal one), not their efficacy.
This 10-15% refers to different procedures, not failure rates. I wouldn’t go to an NP for brain surgery, but for the vast majority of medical procedures, an NP or physician assistant will do just fine.
To add to the irony, while Lopitan’s specialty is rheumatology, he is, under the law, allowed to perform brain surgery. I eagerly await his op-ed in favor of restricting his scope-of-practice.
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