What’s the news: New Jersey legislation that would allow advanced practice nurses to provide medical care—including the ability to prescribe medications—without any physician involvement is the wrong direction to pursue, the AMA is warning.
The legislation—Senate Bill 1522 and the companion Assembly Bill 2286—also would give certified registered nurse anesthetists the ability to provide anesthesia care without any physician involvement after minimal hours of practice.
In a letter to New Jersey legislative leaders (PDF), AMA Executive Vice President and CEO James L. Madara, MD, outlined the following reasons for opposing this bill:
- Education matters: Patients want physicians (PDF) involved in their diagnosis and treatment decisions.
- Increasing scope of practice for advanced practice nurses can lead to higher health care costs and lower quality of care.
- Scope expansions have not proven to increase access to care in rural areas.
- Physician supervision of anesthesia care is critically important to preserve the health and safety of patients.
Fighting scope creep is a critical component of the AMA Recovery Plan for America’s Physicians.
Patients deserve care led by physicians—the most highly educated, trained and skilled health professionals. The AMA vigorously defends the practice of medicine against scope-of-practice expansions that threaten patient safety.
Why it’s important: While all health professionals play a critical role in providing care to patients, patients deserve and have a right to have physicians leading their health care team. The current collaboration and supervision requirements in New Jersey law protect the health and safety of patients and ensure all patients have access to physician-led care.
“The AMA has and will continue to stand up for patients who have said time and again they want and expect physicians leading their health care team,” Dr. Madara wrote. “In a recent survey of U.S. voters, 95% say it is important for a physician to be involved in their diagnosis and treatment decisions and 63% oppose allowing nurse anesthetists to perform anesthesia without physician oversight.”
The Garden State legislation would “effectively remove physicians from the care team and set New Jersey on a crash course toward worsening health outcomes and higher costs—all without improving access to care in rural areas as confirmed by multiple studies,” Dr. Madara added. “Simply put, the education and training of advanced practice nurses does not equip them with the skills necessary to independently diagnose, prescribe medications or provide anesthesia care to patients.”
In his letter, Dr. Madara cited recently published research showing that nurse practitioners (NPs)—the most common type of advanced practice nurse—delivering emergency care without physician supervision or collaboration in the Veterans Health Administration increase lengths of stay by 11% and raise 30-day preventable hospitalizations by 20% compared with emergency physicians.
The study “confirmed that removing physicians from the care team is associated with lower quality of care, finding that nurse practitioners demonstrated lower levels of skill than physicians and achieved worse outcomes, despite using more resources,” Dr. Madara noted.
Learn more: Patients deserve care led by physicians—the most highly educated, trained and skilled health professionals. For more than 30 years, the AMA’s state and federal advocacy efforts have safeguarded the practice of medicine by opposing nurse practitioner and other nonphysician professional attempts to inappropriately expand their scope of practice.