Good article -- talks about scope of practice, "supervisory" language, relations/tensions between MDs and APNs (includes CNMs, CRNAs), reimbursement:
"Nonphysician" is a term advanced practice nurses love to hate. Truth is, they know they're not physicians, but their ranks are growing. The APN title encompasses four nursing areas that require advanced degrees: nurse practitioners, clinical nurse specialists, certified nurse midwives and certified nurse anesthetists. According to the most recent National Sample Survey of Registered Nurses, APNs make up 8.3 percent of the total R.N. population, numbering 240,461 in 2004 (up from 196,000 in 2000).
Many healthcare consumers equate the APN with community-based primary-care clinics and physician offices, says Colleen Conway-Welch, Ph.D., R.N., dean of the School of Nursing at Vanderbilt University in Nashville, Tenn. But APNs also provide specialty care in hospital neonatal intensive care units or cardio-pulmonary wards. With APNs providing many of the same services as physicians--and medical students gravitating toward specialty care--APNs seem poised to shoulder greater primary-care responsibilities.
But APNs face some significant obstacles. Licensing regulations that vary by state, some say, hinder many nurses from making the jump to advanced degrees. Factor in perceived competition with physicians and misconceptions about the profession, and it's clear that these "nonphysicians" still have hurdles to overcome before assuming an expanded role in the healthcare landscape. ......