West Virginia lawmakers urged to reject bill eliminating physician collaboration requirements of APRNs
The AMA sent a letter (PDF) to the West Virginia House of Delegates Health and Human Services Committee expressing strong opposition to House Bill 5681, which would allow all four types of advanced practice registered nurses (APRNs) to prescribe medications without any physician collaboration.
In the Feb. 23 letter to Committee Chair Evan Worrell and Vice Chair Michael Hite, AMA CEO John Whyte, MD, MPH, raised serious concerns about patient safety and the potential for increased inappropriate prescribing of medications, including opioids, should HB 5681 become law. He urged lawmakers to vote “no” on the legislation which was scheduled for a committee hearing.
"Compelling evidence from multiple studies demonstrates that removing this requirement could lead to increased or inappropriate prescribing of medications, including opioids," Dr. Whyte wrote, citing research showing that nurse practitioners prescribe opioids more frequently than physicians, particularly when practicing independently.
Dr. Whyte emphasized that 95% of U.S. voters say it is important for a physician to be involved in their diagnosis and treatment decisions and that patients want and expect physicians, the most educated and trained health care professionals, involved in their care.
The letter highlights the substantial education and training gap between physicians and APRNs. While physicians complete 12,000-16,000 hours of clinical training through medical school and residency training, nurse practitioners complete only 500-750 hours of patient care training, and certified registered nurse anesthetists complete about 2,600 hours. Critically, no APRN is required to complete a formal standardized residency.
Dr. Whyte also noted concerning findings about nurse practitioner preparation for prescribing. According to a study in the Journal of Nursing Regulation, "40 percent of survey respondents said they prescribed medications to adult patients less than 10 times during their training and 50 percent of respondents said they prescribed medications to pediatric patients less than 10 times during their training." These findings reveal severe gaps that put patients at risk and underscore the importance of maintaining physician-led care.
The AMA offered to work with West Virginia lawmakers on alternative solutions to address workforce challenges, including expanding access to telehealth, increasing graduate medical education positions, and providing loan repayment programs for physicians practicing in rural areas.
