Doctors, nurses face off over supervision requirement

Posted March 15

— An effort to free some advanced practice nurses from physician oversight is being roundly criticized by North Carolina doctors groups.

The state now requires certified nurse midwives and nurse practitioners to be supervised by a physician. Meanwhile, state law has no statutory rules for the relationship between certified registered nurse anesthetists and physicians.

House Bill 88 would address both issues by repealing the supervision requirement and codifying a collaborative relationship between nurse anesthetists and doctors.

"This legislation will reduce the unnecessary regulatory burden on advanced practice nurses, expand access to care in our underserved areas (and) reduce the cost of health care," said sponsor Rep. Josh Dobson, R-McDowell. "We can do this without jeopardizing the quality and safety of care."

Dr. Conrad Flick, a family practice doctor, disagreed, saying advanced practice nurses are "not an equal substitute" for physicians, who undergo several years more of education and training.

"Who do you want to care for your family in times of need?" Flick asked.

Dr. Paul Rieker, past president of the North Carolina Society of Anesthesiologists, called the legislation "a radical change" that would allow nurses to practice medicine without proper training.

Dobson said the measure doesn't allow anyone to do anything they aren't already allowed to do. Nurse anesthetists already work independently in many rural North Carolina hospitals because one-fifth of North Carolina counties have no practicing anesthesiologists. Meanwhile, the supervision requirements for midwives and nurse practitioners involve paying a physician about $20,000 a year to review charts every six months, Dobson said.

"This provision is outdated and increases the regulatory burden and cost on nurse practitioners and midwives," he said.

Sponsor Rep. Donny Lambeth, R-Forsyth, noted that a majority of North Carolina residents will be 60 or older by 2035, and the state isn't producing enough physicians to meet the demand for health care, especially in rural areas.

"It is time to modernize this outdated law," Lambeth said.

Dr. Bill Ferrell, a Raleigh neurologist and legislative chairman for the North Carolina Medical Society, said there's no increased access to health care in states without physician supervision of nurses.

Patrick Ballentine, a lobbyist for the North Carolina Nurses Association, countered by citing several studies that show no adverse effects on patient health when advanced practice nurses are freed from such requirements.

"Don't let fear and smear confuse you," Ballentine told members of the House Health Committee, who will likely debate the proposal again next week.

Noting the lucrative fees paid by nurses to supervising physicians, he asked, "Is supervision really about patient safety ... or about something else?"

"There is no compelling health care reason to oppose this bill," he said.


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