I have been a family physician for more than 30 years and have learned from my experience that physician-led, team-based care is critical to the delivery of quality health care.
This approach requires collaboration among any number of professionals, including nurses, physician assistants and, when necessary, specialists. But this team must always be led by a physician who is licensed to practice medicine.
Again, I speak from hands-on experience. I was a physician assistant prior to becoming a doctor of osteopathy. The training and education I received to become a physician gave me great insight into the limits of what a physician assistant can manage, and how important the role of a supervising physician is to prevent medical errors.
Unfortunately, bills under consideration in the state House and Senate threaten this team approach and could, potentially, put patients at risk. These bills weaken current state law by dramatically expanding the scope of practice for physician assistants and certified registered nurse practitioners without requiring that these professionals receive the same education and training as physicians.
Physician assistants and certified registered nurse practitioners are trained to handle certain medical conditions. But they are not meant to provide health care without physician oversight and there are good reasons for those restrictions. House Bill 100 and Senate Bill 25 permit CRNPs to practice medicine without physician supervision by eliminating the collaborative practice agreement after three years of physician supervision, clearing the way for them to practice independently. This means that CRNPs would be allowed to independently prescribe drugs, including controlled substances. In addition, CRNPs would act as primary care providers under state health insurance plans.
This is a dramatic increase in the scope of practice for CRNPs that goes beyond their education and training. Such a change may put the health and safety of Pennsylvania patients at risk.
Patients rarely present with one medical problem. Each condition they have interplays and affects their entire health and treatment plan. A health provider needs to be aware of the delicate balance between conditions. The narrowed scope of knowledge and training of a non-physician provider limits a broad scope treatment plan for the patient.
Remember the devil is in the details.
The health and welfare of our Pennsylvania citizens should demand attention to comprehensive care and detailed oversight. If oversight of non-physicians is decreased, the quality and safety of health care will be diminished.
The practice of medicine and the quality of medical care are the responsibility of properly licensed physicians. The DO (and MD) medical model provides professionals with complete medical education and training.
Patient safety and care should be foremost in mind when lawmakers are debating measures to expand practice rights for non-physician clinicians.
Dr. Joan Grzybowski, DO, is a Wilkes-Barre native who currently serves as president of the Pennsylvania Osteopathic Medical Association, which represents more than 8,000 osteopathic physicians in the state.