Let Advanced Practice Nurses Practice Independently

The Hartford Courant

One of the more controversial bills being discussed by lawmakers in Connecticut' s General Assembly would give advanced practice registered nurses the right to practice independently.

Current regulations allow them to practice collaboratively under the supervision of physicians. For example, many practice in hospitals working with surgical groups or in emergency rooms or in large medical specialty groups such as cardiology or gastroenterology. Others work with primary care physicians.

But the nurses have been petitioning for several years to expand their scope of practice, particularly in the area of primary care. Although physicians have been in favor of establishing collaborative relationships with APRNs, most feel that a nurse's training, as good as it may be, doesn't prepare them sufficiently for independent practice.

This is true for specialty medicine such as cardiology or pulmonology. But primary care is a different matter and it seems reasonable that appropriately trained APRNs could practice independently.

What is so different about primary care that APRNs should be licensed to practice it independently?

The answer to this lies in the radical transformation that primary care has undergone in the past 20 or so years, during which I have been practicing. The forerunner of today's primary care doctor, the general practitioner, did just about everything from delivering babies to taking out appendices. But the rapid expansion of medical science and new surgical techniques made it impossible for them to keep up.

In addition, the threat of medical malpractice suits made many primary care physicians think twice about the risks they took on in performing surgery or in handling difficult medical cases.

Today, primary care physicians work mainly in the area of diagnosis and prevention; and coordination and maintenance of care. Many primary care doctors, who in the early years of their careers had treated a wide variety of illnesses, now find that their days are filled mostly with uncomplicated respiratory illnesses, some bone and joint problems, depression, maintenance of diabetes, stable heart disease and hypertension.

Many only maintain an office practice and no longer take care of hospital patients or nursing home patients.

This new model of primary care makes it reasonable to assume that well-trained advanced practice registered nurses working independently could provide many facets of the care that primary care physicians are now doing.

Nurse practitioners practicing independently in primary care is not a new idea. According to a story in The Washington Post on March 24, about 6,000 nurse practitioners already have independent primary care practices. They can practice independently in 16 states and proposals are underway to expand that number to 30.

Considering that the American Medical Association reported recently that by 2020, the primary care physician shortage will be about 46,000 and that it takes about 11 years to train a primary care doctor, it is doubtful that enough physicians will be trained to reduce the shortage significantly by that time. And because it is unlikely that APRNs and primary care physicians will overcome the professional differences that have divided them and blocked attempts at collaborative practices, it seems that the time is right for APRNs to be given the opportunity to practice independently, particularly in the area of primary care.

Edward J. Volpintesta, M.D., is a primary care physician in Bethel.

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