APRNs Provide Care Equal to Doctors, Review Concludes

In a strongly worded letter to the New England Journal of Medicine Jan. 20, leaders of those four groups took issue with the IOM report, saying its "recommendations are not sufficiently evidence-based."

They added that "80% of patients expect to see a physician when they come to the emergency department, with more than half of those surveyed willing to wait two additional hours to be cared for by a physician."

"Although nurses are critical to the healthcare team, there is no substitute for a physician's education and training," they wrote.

In states where nurses and physicians practice independently, "physicians and nurses continue to work in the same urban areas, so increasing the independent practice of nurses has not helped to solve the problem of shortages in rural areas," they wrote.

Last year, the California Medical Association filed a lawsuit against the state's governor for using a Medicare opt-out provision to allow certified registered nurse anesthetists to administer anesthesia without physician supervision. The CMA argued that CRNAs do not have as much training as physicians, and cannot provide care as safely, but the court did not agree. Two months ago, CMA attorneys said had not decided whether to appeal.

The AMA and CMA did not respond to requests for comment.

Maureen Cones, senior nursing practice counsel for the American Nurses Association, said in a telephone interview Tuesday that advanced practice nurses are still fighting for the right to provide care to the full scope of their training and education, especially in many states where physician groups, licensing boards or legislation have limited their practice.