Bill Would No Longer Require Collaborative Agreements Between Nurse Practitioners and Physicians

Liz Jones, June 12, 2009

Nurse practitioners in New York State will be able to practice independently if a bill drafted by the Nurse Practitioners Association of New York passes through the state Senate.

Currently, NPs in New York State are required to have written collaborative agreements with physicians. The extent of that relationship is determined by the physician and NP, and the two parties do not need to practice in the same location, explains Tom Nicotera, director of membership and public affairs at the Nurse Practitioners Association of New York.

The collaborative agreement, does, however, mandate that physicians review NPs' charts every 90 days. But, again, the level of chart review is determined by the physician and NP. "It could be one, it could be 20," says Nicotera.

The Nurse Practitioners Association of New York drafted the bill to accomplish two goals. First, under the current collaborative agreement model, if a physician leaves practice, retires, or dies, any NPs who practice with that physician must stop seeing patients immediately. "This disrupts patient care," says Nicotera. This bill would allow NPs to practice independently; therefore, they would not be subject to changes in a physician's practice.

Second, explains Nicotera, fewer medical students are choosing primary care careers. However, the majority of NPs are involved in primary care, thus helping to fill the gap. "The more autonomous NPs are—the fewer barriers there are for them to see patients—the better off we are," Nicotera says.

The Medical Society of the State of New York opposes the bill, claiming that it poses a patient safety issue, particularly when it comes to NPs treating complex patients.

NPs' training consists of graduate level education and state certification, according to the American Academy of Nurse Practitioners. Physicians must achieve graduate level education and go through three to four years of a residency program (some also choose to participate in a fellowship, which adds another two to three years to their training). Although physicians and NPs do many of the same tasks day-to-day, the difference in training may be enough to negatively affect patient outcomes, the society argues.

"Clearly, NPs are an integral part of the healthcare team, and they manage non-complex patient care in a physician's office very well," says Liz Dears, Esq., senior vice president at the Medical Society of the State of New York, who says her son often sees a nurse practitioner and she is pleased with the care he receives. "But we have concerns about the quality of care they provide to chronically ill patients."

The definition of NPs' roles is broad and changes from practice to practice, and that demands a relationship with a physician, adds Gerard Conway, Esq., senior vice president and chief counsel at the Medical Society of the State of New York.

In addition to patient safety concerns, the Medical Society of the State of New York opposes the bill for fear that it would create healthcare silos. "We should be working not for one type of practitioner to be independent from the others, but integration. We don't think anyone, including NPs, should be carving out separate practices," says Conway.

Nicotera, however, says that the bill was not intended to build silos. Rather, it was created to provide New Yorkers with greater access to healthcare. "There are medically underserved populations in just about every county in New York. We really need to be able to take care of our patients."

He also says that the bill will not affect NP-physician relationships. NPs will continue to collaborate with and refer to physicians when necessary. "Removing the statutory collaborative agreement won't change their practices. Collaboration is a fact of life when you're in healthcare."

New Yorkers might have to sit tight a while longer to see the outcome of this bill. Only a handful of days remain in this legislative session, and recent leadership changes within the Senate will most likely push the decision to the next legislative session, says Nicotera.

Liz Jones is an associate editor in the medical staff market at HCPro. She is the editor of Medical Staff Briefing, and co-editor of Hospitalist Leadership Advisor and Credentialing and Peer Review Legal Insider. She can be reached at
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