Paige Peters Podcast

During flu season, there is high demand for healthcare services, but appointments are difficult to get due to limited availability. The scope of practice laws in the US are being questioned, with nurse practitioners, dental hygienists, and physician's assistants seeking to expand their roles. The AMA opposes this expansion, but it could potentially lower healthcare costs and provide more care to the uninsured. Research shows that nurse practitioners and physician's assistants play a vital role in primary care, but they face restrictions in many states. There is debate over whether their expanded roles would compromise patient safety. Nurse practitioners and physician's assistants should be allowed to have a greater scope of practice to improve access to care and reduce costs. Limitations in research exist, but expanding scope of practice laws would benefit families and individuals who struggle with healthcare costs. Nurse practitioners and physician's assistants have been found to have As flu season comes around and many people are trying to go to the hospital or doctor's offices and they can't seem to get into or create appointments with them because of the high demand, I feel that it is best to be looking at the scope of practice laws within the U.S. Nurse practitioners, dental hygienists, and physician's assistants, which they are also trying to change their name to physician's associates, are having issues trying to expand the scope of practice laws. The approach of the AMA is very against the expansion. They do not feel as if it would be beneficial to patient care to be able to expand the practice laws, which I feel is important to be looking into because many people are uninsured and being able to expand it so nurse practitioners, physician's assistants, and dental hygienists would be able to do the work similar to what a physician could do, may be able to lower the costs of health care and be able to provide more care to people around. To begin the podcast, I'll be going over some research that I found and then I will be continuing on to, unfortunately, Christine Ogle, who is a nurse practitioner in the state of New Jersey, could not be with me, but I will be going into some questions I had asked regarding how it is in New Jersey, her education, and her experience so that we can look into and see if the scope of practice laws should be expanded and what is different compared from New Jersey to other states who do not have as little restrictions. Provided by Zhongyong Park and others, a comparison of nurse practitioners, physician's assistants, and primary care physicians' patterns of practice and quality of care in health centers, along with to what extent are state scope of practice laws related to nurse practitioners' day-to-day practice autonomy. It has been found that health centers rely on nurse practitioners and physician's assistants and it increases the primary care visits. The use of PAs, which are physician's assistants, and NPs, which are nurse practitioners, were created as a career because they were in a demand for primary care providers and there was an uneven distribution of primary care physicians. Because of that demand, they're able to create this career and it allows them to be able to practice and give health care to those who are in need. It has been found to have a greater autonomy with a greater scope of practice within these middle line physicians. Nurse practitioners attend graduate school, they follow undergrad so they can have the ability to treat and diagnose those conditions that range from acute to chronic, but they're still held to restrictions in 29 of the states, not including the District of Columbia, which is D.C. The AMA has stated that the hierarchy should be withheld in midline physicians such as physician's assistants and nurse practitioners should be on a physician-led team that ensures quality and safety of patients. Many people, though, do question. Many of the uninsured Georgians do question this because there is not much research that shows that nurse practitioners and physician's assistants doing the work of a physician alter the quality and safety of patients. Nurse practitioners and physician's assistants should be allowed to have a greater scope of practice. There are benefits of having a greater scope of practice laws that allow more patients to be treated. It reduces cost of health care. There would be more access by allowing nurse practitioners and physician's assistants to be at places like a Rite Aid or a CVS when they can treat and look at patients when necessary so that they don't have to be put on a waiting list because physicians are in a shortage in specific areas. The difference between nurse practitioners and physician's assistants could be the nurse practitioners, they promote health, they prevent disease, they educate people on health. Some nurse practitioners can even practice without physicians overlooking, but that is based upon state law, which we are trying to expand. Physician's assistants, they resemble medical school, but they must be a part of a team with physicians leading in all states, which forms that hierarchy that the AMA wants to continue having. Based upon the two documents that I had previously mentioned, there's data that shows the associate of practice laws in 2012, and there were five day-to-day practice autonomy measures, one being nurse practitioner skills being utilized, two being the billing under a provider or clinic, three, hierarchical or collaborative relationship with physicians, four, managing panels of patients, five, hospital admitting privileges. Using a Chi-square test and unweighted data and a sample of around 3,470, a more qualitative study was done to determine the characteristics of practice autonomy and the variation between the states, states with independence and restrictions to prescribing medications, states with restrictions but the ability to prescribe medication, and states that were independent with no authority to prescribe medication. Based upon the results of the Chi-square test, there were around 84% that said they have a collaborative approach with a physician, but billing under their own provider number, having management under their own patient panel, and ability to have privileges to admit into a hospital is below 50%. There were no significant differences between individual practice, restricted practice, and restricted prescription practice for the privilege of hospital admittance. Nurse practitioners, though, with full practice and the ability to prescribe medication were found to use their skills, independent billing, collaboration with physicians, and manage their own patient panels. Now if we look at the limitations of the study, although there is a large sample, the limitation could be the possibility that technology used to eliminate a nurse practitioner survey result because there's no way to tell if the deletion of the sample was valid based upon the possibility of it being the same nurse practitioner and not being a definitive answer. I also feel as though since one of the logistic regression graphs only consisted of primary care nurse practitioners and specialty care nurse practitioners, the workplace was recorded and there was no record of those who work in retail clinics. Similarly to the ones I had previously said, the CVS, Rite Aids, I feel as though if those were recorded, it would be able to give a good dynamic of the research done so that we can understand what they are capable of doing in their work setting compared to what is done in specialty care nurse practitioners, which are typically placed in doctor's offices, and the primary care nurse practitioners, which are also like family doctor's offices but can also be in the hospital. Because of the lack of research that has been provided and that has been done on the nurse practitioners and physician's assistants, because this is a newly found problem where people are saying that we do need more physicians that can take care of patients, the implications regarding families and everyday people, being able to expand the scope of practice laws would allow efficiency and it would reduce the cost for families who can't afford physician's prices. The U.S. in general is already having issues with healthcare costs, health insurance. Many people cannot afford it because of the cost in the U.S. Being able to lower the cost for families who can't afford physician's prices is so important because we are having people that are terrified of going to the ER or seeking care when they need it because of the pricing. I mean, insurance is already very expensive and there are issues like if you're not employer-based insurance, it's very difficult to get. And not allowing nurse practitioners and physician's assistants to expand their scope of practice to allow there to be more help when people need it. Nurse practitioners and physician's assistants have been found to have a greater number of primary care visits than primary care physicians. So why is it that they are not trusted in specific states to be able to prescribe the medications to see patients without having to speak to a physician? If the question is about experience, why is it that they can't say, oh, physician's assistants and nurse practitioners or dental hygienists are able to do this after they are a specific amount of years into the work and they know what is going on and they've met and worked with plenty of physicians through their time? There's so many factors that go into it, they can't just limit it on specific data, rather they need to make the greater picture and look at all of the experience, all of the hours spent in the hospital, what they are doing time to time and use that rather than just saying they didn't go through the schooling that the physicians went through. If you're worried about experience, why don't you look at the jobs and the careers and how long they've been doing it and realize through that. Going off of that, I had the pleasure of being able to reach out to Christine Ogle. She is a nurse practitioner in the state of New Jersey. The first question I had asked her was, what are you allowed to do as a nurse practitioner in New Jersey? Her answer was pretty much anything a doctor can do. She assesses and treats patients. She manages their care. She prescribes medications autonomously. She performs procedures, sometimes she's able to go into the OR. She works in the private practice and she also works in hospitals. Another question that I asked is, what is the experience like in the hospital compared to the private doctor office you work in? She had replied, in the office I am the intensive care unit for patients in critical care post open heart. She weans them off from the vent, she gives cardiac drips, oversees their progress and gets them ready to move to the step down floor. She inserts catheters, chest tubes, dialysis catheters. She runs codes when they're needed and she is a part of the life and death situations. In the office, though, she is an aesthetic nurse and she treats patients aesthetically. She's a practitioner overseeing the RNs, the techs, etc. and she's a licensed practitioner for the day overlooking if any emergencies arise. She is the one that is there in place of a doctor. She has been a nurse practitioner for 10 years since 2013. She attended Drexel University in the acute care nurse practitioner program in Philadelphia. She had to have at least five years of clinical care experience to get into the program and needed an 85 or better to pass the program. I had asked her about the scope of practice laws being different state to state and she said, as a nurse practitioner, I can practice autonomously and a PA needs to work under a doctor in New Jersey. For a nurse practitioner, she does not need doctor approval to practice or write prescriptions and just needs a collaborator. Once I have that, I'm on my own in decisions regarding patients. PAs cannot practice on their own. Everything needs to be co-signed by a doctor, so that is the difference between nurse practitioners and PAs in New Jersey, which makes me question why is it different if they're both middle line physicians and PAs go through schooling similar to med school, just not the same residency. I had asked her about how she feels about hierarchy with doctors overlooking and she had said she can't answer it because she's not overlooked by anyone and she has not had the experience a patient had wanted a doctor instead and she has seen as a doctor and patients typically call her doc. She was suspicious regarding information about nurse practitioners and physician's assistants. Christine Ogle had also said that she was a nurse for 15 years before becoming a nurse practitioner, so she does have the experience and she had the experience to allow people to trust her, so why is it that the AMA cannot see that experience is also spoken for rather than having to go through residency and many years of med school, rather why don't we take for account the experience and the many years that are in the career before dissing the idea that nurse practitioners, physician's assistants or dental hygienists could care for patients without the overlooking of a doctor. Thank you for your time. I apologize for my voice. I'm still getting it back after being sick last week, but I hope you all can understand the importance of nurse practitioners and PAs and that they should be able to do more than what they are allowed in specific states and the restrictions do not allow them to work to their full stability.