My Turn: Arizona nurses need more power to practice

Having spent more than 50 years in the medical profession before retiring last year, I had more education, training and experience practicing medicine than most doctors in the state. Does this mean that patients should have been allowed to see only me as their provider? Of course not!  

But that is, essentially, the logic of the Arizona Medical Association in opposing  Senate Bill 1473. This proposal before the Arizona Legislature would grant Advanced Practice Registered Nurses (APRNs), who have obtained a graduate nursing degree and met training requirements, a limited license and greater autonomy to practice, without physician supervision, the health care areas in which they have specialized training.  

The bill also gives some highly qualified APRNs with extra training and experience the authority to write prescriptions, but only within specific and narrow medical circumstances. Notably, this does not extend to opioids for self-administration.

Another provision allows specialized nurse anesthetists to administer anesthesia without the direct supervision of a physician. In response to the proposal, the doctors’ group starkly warned that patient care and safety would be at risk. According to the group's press release, “The suggestion that advanced practice nurses can function at the same level of proficiency as their physician counterpart is not only dangerous, but compromises patient care.”

But real world evidence proves that claim false.

Bill proposes merging of state health licensing agencies within ADHS

Half of all states already have enacted all or most of the reforms in this bill. And a 2010 report by the Institute of Medicine found that “no studies suggest that APRNs are less able than physicians to deliver care that is safe, effective and efficient.” Clearly, these changes won’t compromise patient care, or half the country wouldn’t allow it.

After decades of experience, this data comes as no surprise to me. Despite my “superior” medical training, I depended on the nurse anesthetists on my surgical team to exercise their own judgement for the anesthesia needs of my patients. That is because they had more education and training in anesthesia than I did.

To be licensed under the provisions of the proposed legislation, a nurse anesthetist would be required to have 7-9 years of both training and practical experience, including more than 500 hours of supervised anesthetic administration. This is far more training than a doctor is required to receive.

For a doctor to get an unlimited license to practice medicine, including anesthesia, he or she needs only four years of medical school and one additional year as an intern. There is no specific requirement that an MD have anesthesia training.

We need to remove barriers that prevent health-care professionals from providing the care they are trained to give. And this legislation does exactly that — and safely.

The reality today is, big medical centers and affluent communities have access to a wide array of physicians, including specialists like anesthesiologists. But in many of Arizona’s rural areas, and in some of the poorer neighborhoods in our cities, nurses are often the only available health-care providers. 

Allowing APRNs to practice to the full extent of their education and training will not only benefit our health-care system in Arizona, it will provide more access to care for those with the fewest options. It is just what this doctor ordered. 

Murray Feldstein, M.D., is a visiting fellow at the Goldwater Institute. He is an assistant professor emeritus at the Mayo Clinic Arizona.