MD, DO, NP, DC, OD -- Who deserves to carry the title Physician?

  1. our professional scope of practice asserts that our role is to assess, diagnose, and treat in health and illness.

    from assessing, diagnosing, treating - diabetes, thrombosis, heart disease, infection, emphysema, hep c, hiv, etc, to rendering prenatal care, and preventative care - we are primary care providers. we make life and death decisions each day with our patients in managing disease - thrombosis management and prevention; hep c management; hiv management, heart disease and cva management; women's health - yet we are given less legitimacy in the social security act and cms section 410.20 than a chiropractor or optometrist.

    i have nothing against chiropractic physicians mind you, but take a look at chiropractic.
    cannot prescribe - not even an aspirin
    procedures? - scant more than "moist heat";
    assessment - can't even look into your ear according to their scope of practice
    educational requirements? - a bachelors degree?, nope - about a year and a half of college study (90 credits), a 2.5 gpa, and 3 yrs of study at a chiropractic school.
    how do chiropractors see themselves? go to http://schools.naturalhealers.com/lifewest/
    chiropractic is a total-body healthcare system, and not a method of pain management. as a gatekeeper for direct access to the health delivery system, the responsibilities of the doctor of chiropractic as a primary care clinician include wellness promotion, health assessment, diagnosis, and the chiropractic management of the patient's health care needs. when indicated, the doctor of chiropractic may also co-manage, consult with, or refer to other health care providers

    optometry - about the same. 65 college credit hours (a year and change), 2.5 gpa, a 4 yr program. -- then - slit lamp, snellen, better or worse, eyeglasses or contacts? see you in two years.

    that's all fine. but, here's the rub. the chiropractor and optometrist - according to section 1861(r)(1) of the ssa,and cms sec. 410.20 -- are designated a physician with all of the privileges and honors of that professional designation.

    the apn? nope. even though our scope of practice is much, much broader; our responsibility and liability - far greater. yet we are still treated as hand-maids, and put in our place as second class providers - the extenders, the mid-levels. none of us treat mid-way; perform half of a procedure; help the patient heal only half the way through a disease.
    does any other primary care provider treat heart disease more or differently than you as a provider treat heart disease? does the physician carry more responsibility or liability? no. a pcp is a pcp. and god bless all of us, md, do, apn.

    there is no comparison.the nurse practitioner's contribution to the health of our nation is every bit as important as the md, or do, and far above that of the dc or od. in the clinic we shoulder the responsibilities and liabilities - every one of our actions or inactions as a provider -- every moment we spend with a patient is legally ours to bear alone....

    yet how many times have you been told - sorry, we need a physicians signature on that... you can't order that - it has to be ordered by a physician. we can't send that to you - we have to send it to the physician. sorry, we only credential physicians.

    am i the only apn that feels a little bewildered and disgusted by this?

    i have no innate yearning or desire to be called a physician mind you, its not an ego thing. but what i do have is a desire for, is to be respected for my role as a primary care provider by hospitals, insurers, labs, etc, so that i can do my job.

    why i'm writing this.
    as health care and our roles evolve, i believe that it is our responsibility to lobby for the advancement of our professional role, and with that updates to the ssa and cms sec. 410.20, two of the main documents that define the apn to other professionals. this is critical so that other professionals will not be confused about our role, our education, our abilities, and our responsibilities to our patients.

    we regularly talk about fighting battles in my home state of tennessee, but are we only treating the symptoms of our professional legislative, political, and administrative woes? - shouldn't we also be addressing the root problems from which most of these arise - such as our absence from ssa 1861(r)(1)and cms sec. 410.20.

    it may be time for each individual apn to write, call, or otherwise encourage other apn's as well as our advocates at ana, and our legislators to argue in favor of apn pcp's inclusion in cms sec. 410.20 and ssa 1861(r)(1).

    because as the role of the nurse practitioner continues to evolve in response to changing societal and health care needs, so should the ssa and other government acts that define us to the nation.
    social security act 1861
    http://www.ssa.gov/op_home/ssact/title18/1861.htm

    so. if you agree, take a moment and write someone. don't sit back and do nothing. change happens because of you. write a short note to your local chapter of ana, the national ana, george bush, your senators and your representatives and voice your desire for an updated cms sec. 410.20 and ssa 1861(r)(1) to help apn's across the nation do their job. thanks gang. http://www.firstgov.gov/contact/elected.shtml

    respectfully,
    r. martin
    family nurse practitioner, chief manager and primary care provider
    campbell station primary care associates
    11541 kingston pike, ste 101
    knoxville, tn 37922
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