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If the U.S. Lacks Doctors, Can Nurses, Optometrists, and Pharmacists Take Their Place?

Cheryl Clark, April 26, 2010

Nurse practitioners seek the ability to set up office practices and, if needed, admit their patients to a hospital without a physician's okay.

Physician assistants, physical therapists, respiratory therapists, and many others also are hoping to expand their ability to practice without being directly observed by another provider. For example, dental hygienists in many states are hoping to work not only in different locations than dentists, but patients would make appointments with them for routine cleaning—not with the dentist—unless they needed follow-up care for dental disease.

In California, efforts are underway to give psychologists the right to prescribe certain medications, perhaps with oversight from a physician such as a psychiatrist.

Podiatrists' purview varies from state to state, but in many parts of the country they seek expanded scope of practice so they can operate not just from the ankle down, but up to the knee, something that is frowned upon or prohibited in many states now.

Optometrists no longer just prescribe eyeglasses and correct vision. Now in many states, especially rural areas, they diagnose and treat glaucoma and retinal diseases, and sometimes screen for thyroid irregularities and endocrine imbalances that manifest in the eye. In some communities, they routinely take blood pressure readings, advise on diet and exercise and treat diabetes.

Pharmacists seek to be able to give vaccinations against influenza and pneumonia in their clinics.

And chiropractors seek to perform manipulation procedures on their patients while they are under anesthesia.

Linda Whitney, interim executive director of the Medical Board of California, says much of the concern about physicians needing to oversee what other health practitioners do under their supervision is alleviated with expanded use of telemedicine.

"Now that we have telemedicine, you may have even better oversight if you think you may need to have that supervision," Whitney says.

Collier says that much of this expansion is coming at the same time that health sciences education is undergoing change. Audiologists now receive clinical doctorate degrees and nurses seek special training in oncology, midwifery, gerontology and neonatal care.

Surely there will be turf wars and the battlegrounds may get ugly. But if there aren't going to be enough physicians, who will provide this care?


Cheryl Clark is a senior editor and California correspondent for HealthLeaders Media Online. She can be reached at cclark@healthleadersmedia.com.

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