The American Medical Association Attacks Independent Practice Status for Nurse Practitioners

Lesson 15: Healthcare for Policymakers

The AMA has attacked the independent practice status of nurse practitioners— again— in this article: “How family nurse practitioners’ training comes up short.” This country is in the middle of a primary care crisis. Nurse practitioners are a key to solving that problem. The AMA would do better to help their members understand how nurse practitioners can best help solve that problem.

Our country also is in a chronic disease crisis. Nurse practitioners could help solve that problem as well. Type 2 diabetes is 7 times as common as it was a few decades ago because of an increasingly overweight and aging population. Our health care system is not designed to deal with that change. It is still designed to deal with acute health needs like heart attacks and amputations rather than prevent heart attack and limb loss.

There is an article in one of the leading diabetes journals “How Our Current Medical Care System Fails People With Diabetes.” It describes how advanced primary care teams featuring nurse practitioners are the only way to improve care of these patients.

Many changes in care make sense but don’t improve results. “Many approaches have been tried to improve diabetes care but, with one exception, have been mostly ineffective. These include simply reminding patients about appointments; providing laboratory information on the patient to the physician, even when specific treatment recommendations for the individual patient were included; case management when the case manager could not make independent treatment decisions; education of physicians; and multifaceted quality improvement interventions in the practice setting.”

“The one approach that has proven to be effective is using specially trained nurses or pharmacists, under appropriate supervision, with authority to make medication changes without consulting the physician as long as the changes fell within approved treatment algorithms.” Now, that evidence is an opportunity to improve the care of diabetes and related conditions while taking a huge step forward in solving the primary care crisis. One of the most needed primary care services is managing chronic diseases like type 2 diabetes at a high level of excellence. Nurse practitioners are especially effective in this work because they are accustomed to systematic approaches like standardized care pathways and standing orders. The evidence proves they are essential to provide the best results.

Nurse practitioners can practice independently in over half the states. They can be part of virtual advanced primary care teams to treat type 2 diabetes and related conditions that can support them with protocols, continuing education, and information technology to support providing care and measuring clinical and financial outcomes. These remote resources can support a very high level of care in underserved and rural areas. These places can have world class care now if we do what needs to be done and it can make a huge difference. If we compare the care we have now with the care we could have, patients with type 2 diabetes could have one fourth as many heart attacks, one fifth as many strokes and one sixth as many going on dialysis. They could be healthier and live 8 years longer, but it will not just happen. Professional and community leaders must come together to make it happen. We are prepared to support these virtual teams.