Fighting for independence: NPs vs. the 50 states

The Pennsylvania legislators have finally seemed to get on board with nearly half of our 50 states to break the cumbersome bonds of collaborative agreements.  Right now, nurse practitioners are being forced to practice under a two-physician contract agreement in order to give routine care to Pennsylvanians who desperately need medical care.

This desperation stems from two things.  First, the health care system has been and continues to be in a state of shambles.  Second, and most urgent, is the little-known fact that the nearly 11,000 nationally certified nurse practitioners in Pennsylvania are being held to a decades (decades!) old law that requires NPs to “collaborate” with not one, but two physicians in order to practice.  There are about 38,000 active physicians in Pennsylvania (General Assembly of the Commonwealth of Pennsylvania, 2015, p. 11).  Many physicians do not want to be bothered with the cumbersome paperwork slowly, ever so slowly processed by the Pennsylvania Board of Nursing.  Although the website states two weeks, it is more like two months to process.

Worse yet are physicians who never step foot into an NP-led practice, typically in rural areas, but they are named as collaborators.  And the NPs pay on average $5,000 annually each to those physicians just for a signature.  It’s like being held hostage but never getting the resolution.

Should one of those “collaborative” physicians retire, fall terribly ill (think stroke), or die, the nurse practitioner must stop practicing.  I personally know an NP who owned her own clinic in a rural area and did house calls when one of her collaborative physicians had a stroke and retired.  No warning. It just happened.  And until she found another doctor to agree to sign on, she had to close her practice.  Three weeks.  Closed.  Patients had no care for three weeks. Tell me, after over 15 years of practicing, how is that fair?  Will her mortgage company cut her a break?  Her light and power company?  No.  Not any more than that Commonwealth of Pennsylvania.

Fortunately, the legislators of the great Commonwealth of Pennsylvania have passed SB717 and now it will head to the House of Representatives.  The Pennsylvania Coalition of Nurse Practitioners (2017) states, “Senate Bill 717 and House Bill 765 would end this costly, arbitrary and outdated mandate and make Pennsylvania a full practice authority state.”

Already, 21 other states plus the District of Columbia have granted full practice authority to their NPs.  However, Pennsylvanians in rural and underserved areas may soon be able to rejoice as NPs who have completed an unprecedented three-year “training period” and 3,600 hours under the aforementioned collaboration agreement would be able to apply to work independently.  (One can only imagine how many months it will take the PA Board of Nursing to process the flood of applications).

It is maddening, as a doctoral-prepared NP, that I should have to work with two physician collaborators.  If the Pennsylvania branch of the American Medical Association, who has fought this break in antiquated wink-wink boys’ club tradition was so concerned about the health of Pennsylvanians they would have jumped in to break the collaboration and made physicians available via a hotline to support what they call “mid-level” practitioners.  Instead millions have been wasted on both sides and years have gone by while tragically underserved Pennsylvanians, my neighbors, people I know and have heard of via word of mouth, have suffered with no access to care.  No. Access.  To.  A.  Medical.  Doctor.  Or.  NP.

There are plenty of patients who prefer a board certified physician.  And I have learned under and alongside wickedly intelligent physicians to whom I will always be grateful.  But there are also patients who love NPs and welcome our prevention as well as treatment modality.  There is enough room for everybody.  We should respect each other. Stop throwing verbal stones.  However, aside from that, get rid of the collaboration agreement.  And once that is done, fix this new, upcoming law because even when it is passed, Pennsylvania’s collaboration will remain the most antiquated in the entire 50 states.  And that, my dear friends, is unacceptable.