A proposal by the Veterans Health Administration to allow nurses with advanced training to practice medicine without physician supervision could be a model for future expansion of the role of pharmacists in patient care.
An interesting article, “The Nurse Will See You Now,” published in The Wall Street Journal on January 27, 2014, focuses on criticism directed at the Veterans Health Administration (VHA) regarding a proposal to allow nurses with advanced training to practice medicine without physician supervision throughout the VHA system—even in states where the law requires more oversight. As one might expect, nursing organizations are expressing a favorable reaction to this effort, while medical organizations are opposed. Is this a quality-of-care issue or a pocketbook issue? You’ll have to answer that yourself, but it might be a little of both.
Why is this happening at the VHA? It hasn’t been implemented yet, but I think there may be several reasons behind this proposal. Primary care doctors are in short supply. Evidence suggests that nurses with advanced training can handle this role very well. Even the Institute of Medicine issued a report stating that nurses with advance training should practice at the top of their license. Interestingly, pharmacy leaders have begun to say the same thing about PharmDs.
Quality care can be delivered at lower cost, and most of health care these days is focused on improving care while reducing cost. State practice acts vary, making it difficult for a national entity to provide consistent care following a similar model and still comply with state laws.
What does all this mean for pharmacy? You might say nothing, because the current controversy at the VHA involves doctors and nurses, not pharmacists. But as pharmacists begin to be recognized as chronic disease care managers, could similar opportunities emerge for us within the VHA? I think it is a real possibility.
Could activities like this jumpstart a real movement to start national licensing for health professionals, particularly if consolidation happens regionally or nationally? I think that’s possible as well. Someone once said to me that as health care becomes nationalized (or socialized), physicians will lose power and other health professionals will gain it. Is that what we are seeing here?
Although you may view this issue as a professional decision, I suggest that in large part it is a political decision, too. What I took away from the Wall Street Journal article is that if pharmacy can get really organized behind the provider status initiative, we might be able to move our profession forward. Do you agree and are you involved?