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Press Start: Lead an Empowered Life as a Clinical Laboratorian

Primary Care Dispute Brewing

Published April 10, 2010 5:46 PM by Glen McDaniel

Over the years several healthcare professionals, especially nurses, have been successfully expanding their scope of practice. Generally these are professionals with additional training  and possibly advanced degrees-but not always. They perform tasks intermediate between say a registered nurse and a physician.

To many people this is a win/win situation: patients have increased access to medical care and the professionals enjoy job enrichment. Some states have granted nurses the right to prescribe drugs and even to bill directly for services.  Some payers now pay nurses upwards of 85% of what they pay physicians for essentially similar services.

In recent years physicians have been getting a little uncomfortable with what they see as an encroachment on the physician's scope of practice-and income. Not surprisingly the term -and need- for such professionals differ based on who is talking. Nurses say patients benefit, and they call themselves advanced practice nurses (APNs).  Physicians say patient safety can be endangered and they refer to these individuals as physician helpers, physician extenders or limited licensure practitioners.

It's interesting that two groups that have fought clinical laboratory personnel licensure in the past are now battling each other. The fight has been heating up for a couple of years now as competition has increased and the scope of non-physicians has expanded. 

This tension has intensified especially with the new healthcare reform. Nurses see an opening to fill the increased need for providing primary care to the millions of individuals who will now have paid access to healthcare in an arena of physician shortage.

The American Medical Association has not taken this lying down. They recently put out a group of reports indicating that, for example, the doctorate of nursing practice  (DNP) is not equivalent to an MD -as some nurses have claimed. They are quick to point out that some APNs do not even require a master's degree, depending on the state.

The AMA Scope of Practice Data Series give talking points and strategy to state medical societies and medical boards urging them to fight the ever- expanding  scope of practice of APNs such as certified nurse practitioners and certified registered nurse anesthetists. But the data seried also targets other potential competitors like  dentists, optometrists, pharmacists and psychologists.

Nurses have fought back by saying physicians do not have the right to regulate another sovereign profession. Sounds familiar? It's interesting that in Georgia pharmacists have repeatedly sought to exempt themselves from any regulation while they perform laboratory testing. The recent attempt to de-regulate the laboratory profession in Georgia was led by a nurse.

It will be interesting to see how this pans out and whether nurses for one will be more supportive of independent practice by clinical laboratorians, including the right to have personnel licensure.

Will there be cooperation for the public good or will it be every man and woman for him/her self??



Mary, they don't even know u exist.

shun duear, mt May 2, 2010 2:05 PM

We have a shortage of physicians in this country. Plus new doctors are not going into primary care because they can get more money in other specialities like radiology and so on.

It makes sense that for routine visits physician extenders like nurse practitioners and physician assistants should help with some of the light-duty stuff. If you are feeling sick, or if you have had NO medical care, it is better to have them than to have no one at all. But they are definitely not doctors and should not claim to be able to perform just like doctors.

I think it is intteresting as Glen says that nurses and doctors in some states have joined forces to fight us on  independent licenses, and now they are fighting each other. I wonder if they will want us to pick sides.

Mary B. April 15, 2010 2:29 PM
Roanoke VA

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