AAFP Criticism of Unbalanced Webinar Prompts Response From State Legislatures Group

Panel Calls for Nurses' Scope of Practice to Equal That of Physicians

February 01, 2011 05:30 pm News Staff

After reviewing the contents of a recent webinar on advancing health care through nursing released by the National Conference of State Legislatures, or NCSL, the AAFP sent a letter to the group indicating the Academy's disagreement with the content of the webinar and noting that the physician perspective was missing from the event.

The webinar was a "scope-of-practice presentation" that "clearly advocated for a position determined by vague and unreliable data, making this webinar uncharacteristic of the NCSL," said AAFP Board Chair Lori Heim, M.D., of Vass, N.C., in a letter to Massachusetts State Sen. Richard Moore, D-Uxbridge, president of the NCSL.

The AAFP has worked for years with the NCSL, which is a bipartisan organization that provides opportunities for policymakers to exchange ideas on state issues, including health care.

According to Heim, the participants in the NCSL webinar cited the Institute of Medicine, or IOM, report, The Future of Nursing: Leading Change, Advancing Health(www.nationalacademies.org), and called for a much greater role for nurses in the health care system, including allowing them to expand their scope of practice to equal that of physicians. The AAFP has assailed the IOM report for failing to adequately address the training and certification nurses will need to assume greater responsibilities in the health care system.

In her letter, Heim said "one panelist explained that 'decades of evidence' show that advanced practice registered nurses, or APRNs, are not only as effective as physicians in providing primary care, but are often more effective. However, when asked to cite the primary research evidence, only the recently published tertiary studies by the Institute of Medicine and Macy Foundation were referenced."

Heim pointed out that the webinar panel asserted nurses should be able to practice as physicians and claimed that an APRN's education is more than just book learning. But no one specified "the curricular or clinical requirements to receive such a degree," said Heim.

"We are more than happy to clarify that whereas doctors of nursing practice, those APRNs with the highest level of education and training, receive at most 3,500 to 6,000 hours of combined education and training, primary care physicians must complete 20,700 to 21,700 hours of postgraduate clinical training," Heim said. "The panelists failed to distinguish how this education and training difference of up to 17,200 hours is insignificant."

The panel also made the case that registered nurses should be allowed to practice independent of physician supervision to meet the high workforce demands created by the Patient Protection and Affordable Care Act, said Heim. But the panel neglected to mention that currently, 36.1 percent of registered nurses have an associate's degree, 36.8 have a baccalaureate degree and only 13.2 percent hold a master's degree or doctorate.

By comparison, said Heim, primary care physicians have a baccalaureate degree, a four-year doctor of medicine or osteopathy degree, and an additional three to four years of residency training, including 15,000 hours of clinical training.

"When a patient presents (with) symptoms or conditions beyond an APRN's training and licensure, the patient is referred to a physician for follow-up, adding health care costs for both the patient and the system," Heim said.

A more balanced panel would have emphasized the importance of a health care team built around the patient, said Heim. "Teamwork is the essence of high-quality patient care and the foundation of the patient-centered medical home, or PCMH, in which patients receive comprehensive care at an integrated physician-led practice."

In response to the letter from the AAFP, the NCSL's Moore said the NCSL was committed to providing legislators and legislative staff with unbiased, bipartisan policy information. "The purpose of this webinar was to share with our members the findings of the Institute of Medicine report on the future of nursing," said Moore. Upon further review, however, he noted, NCSL staff decided the 'webinar would have been improved if it had included the physician perspective.'

The AAFP also was one of nearly 80 organizations that signed on to a letter to the NCSL from the AMA that expressed similar concerns about the nature of the NCSL webinar and the lack of the physician point of view. "State legislators deserve to hear all sides of these critical issues," said the AMA letter. "Unfortunately, this webinar failed to provide legislators with such a forum. Given the complex decisions facing the nation’s state legislatures, we strongly encourage the NCSL to include the nation's physicians in future discussions."