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 Provided by Clinician 1
I know I don’t have to tell you to be careful when a medical society sends out a letter that starts like this:
“Are you tired of mid-level providers trying to practice medicine without going to medical school? If you are, here is our best chance in years to push back and begin moving the scope of practice spectrum the other way. If we lose, their opportunities to continue to expand their scope will dramatically increase.” And then goes onto say things like this: “TMA has found that chiropractors and other “pain clinics” are employing mid-levels in their offices in order to refer patients to them. We have found that some of the physician supervisors are not even living in the State of Tennessee. These procedures can be dangerous and need to be done under direct supervision of an appropriately qualified physician in order to make sure that the patient is treated safely and effectively”.
It seems the Tennessee Medical Association, like other associations before it, has decided that if a PA or an NP does a procedure and the medical society does not like it, they can just make a few allegations that those NPs or PAs are doing something wrong and follow it up with legislation.
In this case, something a fishy might be going on. Someone (possibly a physician who does these procedures) must have gotten their knickers out of alignment because they felt that PAs and NPs and also CRNAs should not be doing invasive nerve blocks (and more) in a setting that is not a licensed facility without the direct supervision of a physician. What they did was bring this issue to the medical association who it seems introduced legislation to end the practice(s). It seems the TMA also sent out a message to all of their physicians asking for their help. What is puzzling is that the reasons they used for not allowing PAs and NPs to do these procedures were allegations that, if true, were illegal and should have been reported to the appropriate licensing boards. Are there physicians who know that NPs and PAs are breaking the law and not doing anything about it? The allegations reported were NPs and PAs were doing these procedures for and under the employ of chiropractors and doing these with supervision/collaboration of physicians who were not living in the state (whatever that means). As a point of information, a physician can be licensed and practice and have an office in a state where they do not live. That is not illegal at all. If they mean working for unlicensed physicians that is another matter and should be clarified.
What is strange is that I bet the NP and PA leaders of Tennessee would agree that if these things are going on they too would have a problem with them. If the problem is that chiropractors are “supervising” NPs or PAs, this is something I hope they would not favor. I know for PAs, it should be against the law. The part about docs not “living” in the state is ridiculous unless there is a law that says you have to LIVE in Tennessee in order to practice there?
I remember while being President of the New York State Society of PAs the medical society put some accusations about PAs in NY in their monthly newsletter. These accusations were so bizarre we knew they were not going on, but the legislators did not. They included PAs doing “home births” and PAs “running their own hospitals”. We met with the medical society and told them that if they have a problem with PAs please let us know as soon as they hear them. We also asked them to give us the names of the PAs doing home births and the names of these hospitals PAs were running alone. We were ready to prosecute anyone who was practicing beyond their scope of practice. “Surprisingly”, they could not, and these statements never appeared again.
There is a thirty year lesson here. When the NP or PA professions (or both together) are confronted by statements that we know do not generally match our general practice patterns, we must not think they will go away. They will only get more exaggerated unless confronted. The thing that the medical society has going for it is that the public is uneducated in medical matters. So are the legislators. If they hear that “nurses and assistants” are doing something that sounds dangerous to patients, they will not search out the facts, they will start to act, or ask for action. It is time we realized that the only way we counter these claims is to challenge them. To tell the legislators that these are unfounded accusations and that if the professions in question are doing them, we will prosecute our colleagues. That a change in the law would harm the 99.9% of the professionals who are practicing correctly and that changes are not needed. The problems outlined are already illegal so let’s enforce the law. We can start with the person or group who made the accusations and ask them to give us the names of the clinicians/practices in question.
We also all need to work together when these things happen. One of the things that those that oppose us will want to accomplish is to divide us. We can answer separately but must have the same message if we agree.
It seems in this case we surely do.
Let’s ask for those names and see where it leads us.
Dave
 Dave has been a PA, and later NP, leader for thirty years. He strongly believes that NPs and PAs must work together to insure a better future for both professions. Most recently Dave has been busy launching another dream; Clinician 1, the first internet community for PAs and NPs. In October 2008, Dave was honored by the New Jersey State society of PAs with its “Lifetime Achievement Award”.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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