As I follow legislative and policy issues I see a theme. I call it the "I'll have what they are having!" approach. In addition to working toward full practice authority, we put a great deal of effort into making sure that existing policy law is inclusive of advanced practice providers. We are making strides at the federal level toward securing the ability to order things like home health. Makes total sense. You would be hard pressed to find an NP who is philosophically or ethically opposed to ordering shoes for patients with diabetes.
At the state level, we are on alert to watch for new bills that exclude us-whether it is on purpose or from habit. We as a profession have made progress, but the tradition of referring to medical providers as "physician" is not easily changed. Much of the time it can be chalked up to habit, much like we call all tissues "Kleenex" even when we buy the store brands. Sometimes it's actively meant to exclude other providers. This is where a good lobbyist is essential. In addition to catching exclusionary language, lobbyists serve as a constant reminder that we are watching and will not stand by and let ourselves be marginalized. This is how we change the culture.
My concern this past year is that we haven't yet moved past the "me too" phase. A number of issues are on the horizon that should prompt us to consider our position. While we are working on changing the term "physician" to "provider," we should take care not to overlook the big picture. It's not enough to be included; we must start asking ourselves where we stand on the topic ... not just the language.
A number of highly controversial subjects have emerged in healthcare, and we need to weigh in on them as a group. For instance, where do we stand on medical cannabis? What is our position on assisted suicide? Various physician groups have published their stances on these two hot button issues, but we have been mostly silent.
The reason I bring this up is that while we may feel our autonomy is protected by adding our names to legislation, doing so may be shortsighted if we don't first develop a stance. These are subjects that folks are passionate about, some of which may be faith based. It may not seem like a big deal now, but I worry that it could be a very short walk from our professions being eligible to participate in these activities to finding ourselves being compelled to participate. It's time to start thinking bigger.