A Florida bill to expand the scope-of-practice for non-MD practitioners is wildly unpopular among Floridians, according to a poll commissioned by the Florida Society of Anesthesiologists. The poll:
showed 80 percent of Florida voters thought physician anesthesiologists should be the chief decision-makers in the operating room. Another 15 percent said CRNAs “should be on equal footing” when it comes to anesthesia decisions while 5 percent were unsure.
The number of dissenters was cut in half when asked who they would want in the room if they had to be put under — 92 percent said they wanted the MD on hand, while just 6 percent said they would be fine with a CRNA.
Additionally, 85 percent of those polled told Mason-Dixon [the firm that administered the poll] that “giving anesthesia to patients is a complicated and difficult job that should only be performed directly by or under the supervision of a trained physician.”
It is worth emphasizing that this bill would not remove the licensing requirements for these practitioners, but rather undo MD supervision requirements. The bill also includes a specific schedule of how much malpractice insurance these practitioners must carry, and what penalties they would face for certain infractions.
Also important: while the poll focused on anesthesiologists, they are a small subset of practitioners covered by the legislation.
Florida law requires advanced practice registered nurses (APRNs) to practice under a supervising protocol with a physician and only to the extent that a written protocol allows. Likewise, physician assistants (PAs) must practice under a supervising physician and may only perform those tasks delegated by the physician. CS/HB 821 authorizes APRNs who meet certain criteria to practice advanced or specialized nursing without physician supervision or a protocol and authorizes PAs to practice primary care without physician supervision. These APRNS and PAs may act as a patient’s primary care provider; provide a signature, certification, stamp,verification, affidavit, or other endorsement currently required to be provided by a physician; certify a cause of death and sign, correct, and file death certificates…
The bill subjects APRNs engaging in autonomous practice to disciplinary action if they commit specified prohibited acts related to unethical and substandard business practices. Such APRNs must complete 10 hours of continuing education related to pharmacology prior to biennial registration renewal. [Emphasis added]
For those who aren’t familiar with the literature on scope-of-practice for non-MD healthcare practitioners, it’s easy and somewhat understandable to become unnerved at the prospect of someone who isn’t a doctor performing a medical procedure, especially if they aren’t under the direct supervision of a doctor.
But the fact of the matter is that most APRNs, NPs, or PAs can perform many of the procedures we trust MDs to perform, especially in the case of primary care physicians–something many physicians agree with! It would have been interesting to see what the poll found if those surveyed were asked the question “given that non-MD healthcare practitioners can perform the tasks covered in this bill more cheaply and as safely as physicians, do you support this legislation?”
It’s easy to blame this on misinformation and scaremongering propagated by MD industry groups (there’s plenty of it out there), but I think the bigger problem here is intuition. “If you look at the literature” is not a great way to start a stump speech, but the ability to clearly communicate the facts on non-MD healthcare practitioners is crucial for high-profile reforms that would expand access to and cut costs of healthcare in the Sunshine State.