Good medicine

After decades of failed attempts, the nation finally has a law - the Affordable Care Act - that provides the opportunity for nearly all citizens to access health insurance coverage. Yet the coverage does little good if patients cannot get care. This is the major reason why the state General Assembly should approve a bill that would allow nurse practitioners to practice independent of doctors.

Connecticut faces a shortage of primary care physicians, expected to get more acute as members of an aging doctor population move into retirement. The state and nation need to find a way to persuade more doctors to forego specialized medical careers and provide primary care. That will take time. Meanwhile, easing the restrictions on nurse practitioners can help.

In Connecticut, advanced practice registered nurses (APRNs) are required to obtain a graduate degree in nursing and national certification. APRNS are trained and certified to assess, diagnose and manage patient problems, order tests, and prescribe medications.

Yet under state law, they can only practice in collaboration with a licensed doctor. APRNs contend this requirement is needlessly restrictive and limits their ability to see patients and explore innovative care delivery, such as nurse-managed health centers. The mandate causes problems when physicians relocate or retire, leaving APRNs out of service until they can find and sign an agreement with a new doctor.

The proposed legislation strikes a reasonable balance. It would require an APRN to work in collaboration with a physician for the first three years after licensing, before gaining the ability to practice alone, if he or she chooses.

APRNs cannot replace doctors - patients with complex problems, multiple diagnoses or other difficult challenges require the expertise of primary care physicians. But APRNs can help address the growing medical needs of our society and this change in state law would help maximize that potential.

During a recent hearing, lawmakers heard some logical suggestions to improve the bill, including a requirement that nurse practitioners have adequate malpractice insurance and must make clear to patients they are not doctors.

A Connecticut Department of Public Health review concluded there was no evidence to suggest that eliminating the collaborative requirement would adversely affect patient care. The time has come to make the change.

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