More independence sought for 5,000 nurse practitioners

  • Article by: MAURA LERNER , Star Tribune
  • Updated: December 13, 2012 - 9:36 PM

Legislature to debate change in oversight by physicians.

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HealthPartners nurse practitioner Jana Dahn, right.

Photo: Bruce Bisping, Star Tribune

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For years, nurse practitioners in Minnesota have been able to see patients only in association with a licensed doctor. But a governor's task force says it's time to let those nurses work independently -- in part, because of a coming shortage of primary care physicians.

The proposal, which has been opposed by physician groups, was endorsed Thursday in the final report of the state Task Force on Health Reform, headed by Human Services Commissioner Lucinda Jesson. The report is expected to set the stage for a debate in the Legislature, which must approve any changes.

The plan would lift restrictions on the state's more than 5,000 "advanced practice nurses," who get extra training to diagnose and treat many routine conditions, from strep throat to chronic illnesses.

Under current law, they must have a working agreement with a physician, although 17 other states have no such restrictions.

"The reality is that we've got a primary care shortage and you can't turn out doctors fast enough," said Dr. Therese Zink, a University of Minnesota physician who served on the task force. "We can't afford to wait. We need creative solutions."

Many advanced practice nurses already operate semi-independently, running clinics in drug stores, schools, rural areas and other locations, under "collaborative agreements" with physicians. The problem, said Zink, is that if the physician retires and no replacement is found, the nurse practitioner would have to close up shop. "It's probably, more than anything, a rural access issue," she said.

But the Minnesota Medical Association (MMA) says the physician oversight is necessary. "This is a patient safety issue," said Dr. Dave Thorson, a St. Paul physician and chairman of the MMA's board of trustees. "I think nurse practitioners ... do a wonderful job. They're a valuable member of the health care team. But they're not the same as a physician, so they shouldn't be given the same scope of practice as a physician."

The American Academy of Family Physicians also objects to the idea. "Substituting nurse practitioners for doctors cannot be the answer," it said in a report in September. It noted that doctors are required to go through twice as many years of training (11 years) as advanced-practice nurses (five to seven years).

But the trend has been spreading. Today, 17 states, including Iowa and North Dakota, permit advanced-practice nurses to diagnose and treat patients, as well as prescribe drugs and devices, without physician supervision, according to the task force.

One of the driving forces is the anticipated physician shortage, as large numbers of doctors retire and aging baby boomers need more care. National experts predict a shortage of 45,000 primary care doctors by 2020.

"We're trying to stay ahead of the curve," Zink said. "We've got to have solutions that are above and beyond and push the envelope."

The task force report, which includes a broad range of recommendations on quality and access to care, will be posted Friday on the Minnesota Health Reform website, mn.gov/health-reform.

Maura Lerner • 612-673-7384

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