February 2000 • Volume 6 • Number 2
Family physicians discuss turf battles, call for collaboration
BY JANE STOEVER
Scope-of-practice battles continue to be waged in statehouses and among health professionals, but some family physicians are calling for more collaboration and less combat.
"What would you rather do tomorrow, fight with nurse practitioners or improve preventive services?" asks Larry Green, M.D., of Washington, D.C.
"We should work with NPs to organize systems that take advantage of their competencies and ours to close gaps in preventive care," says Green, who directs the AAFP Center for Policy Studies in Family Practice and Primary Care.
Concerning privileging conflicts, Green asks, "Do we want to fight more battles with obstetricians, or should we pour more energy into giving FPs surgical skills to do rural obstetrics?"
Green warns against spending a lot of calories and emotion trying to address border disputes.
Two states have hit on ways to save legislators from the "down and dirty" of turf wars between physicians and midlevel providers:
Since 1985, the Nebraska health and human services department has appointed multidisciplinary committees to study petitions for licensure or expansion of scope. The committees report to the department's board and director, who makes recommendations to the legislature. The committees have stymied requests, for example, for licensure of naturopaths and lay midwives.
"The committee process usually leads to compromise," says David Hoelting, M.D., of Pender, who chairs the Nebraska AFP legislative committee.
Texas nursing, physician's assistant and physician organizations formed a collaborative practice committee a few years ago, at legislators' request. When NPs wanted a law protecting their right to due process in case their hospital privileges were threatened, the committee backed the request, and the legislature approved due process for all with staff privileges.
In another case, nurses with hospice and cancer patients sought authority to prescribe controlled substances. "I told them the Texas AFP had discussed the possibility of that request, and the family physicians were adamantly opposed," says Stephen Benold, M.D., of Georgetown, the committee's Texas AFP representative. "There was no way the committee would reach a compromise, so the proposal was dropped."
Family physicians in other states are wrestling with scope-of-practice issues dealing with midlevel providers. For example:
Mississippi has many health professional shortage areas and more NPs than FPs. "We have a dilemma," says Tim Alford, M.D., of Kosciusko, vice president of the Mississippi AFP. "The areas that we want our NPs to move to are the hardest to supervise, because they're the most remote. We're so overworked, we can't get out there once or twice a week. And patients have problems the nurses have to address right away. As our state turns out large numbers of nurse practitioners, we aren't taking stock of who's going to supervise them."
AAFP chapters continue to back members in privilege battles. For example:
The Georgia AFP is raising funds for members who may need legal assistance to gain or defend their hospital privileges. According to GAFP Past Presi-dent George Shannon, M.D., of Columbus, the chapter asks three questions about privilege problems: How well qualified is the candidate? How dedicated is the candidate to pursuing privileges? How strong is the opposition?
"Hospitals don't like legal fights and don't like to alienate their medical staffs, so you can often negotiate," says Shannon. "You don't really want to call in the lawyers. All they do is lick their chops."
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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