Christine Jordan Sexton
Gov. Ron DeSantis, who has been supportive of many health care proposals pushed by House Speaker José Oliva, said Tuesday he doesn’t back one of the Republican leader’s top priorities: allowing advanced nurses to practice independently from physicians.
Following an AARP town hall meeting on the rising costs of prescription drugs, DeSantis said he would have to be “convinced” about allowing advanced practice registered nurses and physician assistants to work independently from physicians. The House passed such a measure (HB 821) last week.
“My general view is that if you go to medical school and you go through all that training to become a doctor, be a doctor,” DeSantis said when asked whether he supports the legislation.
“My mom’s a nurse, so I have great regard for nurses,” he added. “But it’s a different thing. And so, I would have to really be convinced that kind of expanding scope of practice would be good. “
Oliva could not immediately be reached for comment. But House bill sponsor Cary Pigman, a Republican from Avon Park, said last week the measure would help enhance access to quality care.
“This bill removes the barriers to providers practicing to the full extent of their education and training,” said Pigman, a physician who is chairman of the House Health Market Reform Subcommittee.
The break on the “scope of practice” issue is notable since DeSantis has previously praised Oliva’s view that health care costs can be contained by changing the state’s regulatory framework. The House has also backed DeSantis’ plan to allow the importation of drugs from Canada.
Oliva has dedicated a big part of his time as House speaker to passing legislation that would disrupt the health care system, taking aim at changing laws and regulations surrounding hospitals and other health providers. Oliva also has taken aim at how the state — and individual consumers — pay for health services.
To that end, a top priority for Oliva has been expanding the roles of advanced practice registered nurses and physician assistants by allowing them to practice independently from physicians.
The Senate has been unwilling to move similar legislation during the session that is scheduled to end May 3.
But the Senate in recent weeks has agreed to move closer to the House of Representatives on several high-profile health care bills, including bills dealing with the issues of telehealth and “certificate of need” regulations.
The about-face by the Senate on those issues has led to questions about what senators might do on scope-of-practice issues. Expanding the roles of advanced nurses and physician assistants has long been opposed by physician groups.
Florida Medical Association lobbyist Jeff Scott said his organization had not spoken with DeSantis about the issue this session. But hearing that the governor opposes the legislation was good news, he said.
“Certainly, that makes us feel better than if he had come out in support of it,” said Scott, whose organization is made up of physicians across the state.
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Republished with permission of the News Service of Florida.
9 comments
John
April 23, 2019 at 5:07 pm
It’s funny how he took money from the FAS and FAAS a few weeks before this statement. Has he no shame? He sold out his constituents for bribery and fake studies! We need access to care that HAS been proven in many states! No change in patient safety. This is just plain PAC pressure and greed.
Brad A. Briscoe
April 23, 2019 at 11:13 pm
With regards to proposed legislation to improve patient access to care and lower costs for all Floridians by allowing for full-practice authority for APRN’s; I am very disappointed in the following comments made by Governor DeSantis.
How does full-practice authority for APRN’s impede physician practice? As a retired Navy Nurse/Nurse Practitioner with over 26 years service I’ve experienced first hand the positive impact of having ‘all hands on deck’ – allowing Licensed Independent Healthcare Providers to practice to their full scope. The governor does his constituents a huge disservice.
Perhaps we need to share with President Trump – the governor’s unwillingness to follow his direction regarding healthcare for the nation:
Specifically that “states should consider changes to their scope-of-practice statutes to allow all healthcare providers to practice at the top of their license, utilizing their full skill set. The federal government and states should consider accompanying legislative and administrative proposals to allow non-physician and non-dentist providers to be paid directly for their services where evidence supports that the provider can safely and effectively provide that care. States should consider eliminating requirements for rigid collaborative practice and supervision agreements between physicians and dentists and their care extenders (e.g., physician assistants, hygienists) that are not justified by legitimate health and safety concerns.”
I will certainly be encouraging my peers to do so.
Elizabeth
April 23, 2019 at 11:15 pm
Dr Elizabeth McCormack, FNP, FPMHNP – my comments on the Florida legislature Stop this gender discrimination. I am licensed by the state of Florida. I have my own insurance and the education required to provide care to patients. I should Not have to answer to a male profession in order to practice my profession.
As a nurse practitioner (NP) of 23 years, I have several points to make regarding why NPs should be given independent practice.
First, if the public believes that physician oversight means close collaboration then I need to provide some information. A collaborating agreement is only a piece of paper that says that we can practice. For a signature on that paper, someone has to pay the physician . For the nurse practitioner, it is like this analogy. I have a car, I have been educated on how to safely drive the car, I have a license to drive the car, and I have insurance to drive a car. But, I still have to ask my husband (the doctor) whether I can drive. It is insulting and an outdated discriminatory tactic that has been used to suppress our ability to function. We are suppressed, that is until physicians realize they can use us as money makers. The more NPs involved in practice the more the wealth from our labor is spread. The collaborating agreement is also for control, it is not for providing any physician oversight. The doctor signs the agreement, bills for the agreement, the NPs drive the car and the physicians reaps the benefit of added income from our services.
Second, for seven years, I owned and operated a house calls practice (Nurse Practitioner on Call / NPOC) in Pensacola. During this period I employed at least 3 different physicians, 10 nurse practitioners, 3-4 LPNs, 8-10 LPNs, and 3 different office managers. We also were a site for NP and MA students. I brought amazing jobs to the community, helped others provide for their families and helped others obtain valuable education. Patients were very satisfied with the care that they received.
My NP Company promoted access to care to patients who could not independently leave home for their primary care appointments. At one time my patient population was 30% Medicaid. Without our care, their only option was to call 911 to transport them to the ER for evaluation. As a nurse practitioner, I was able to evaluate the patient in the home, order tests and procedures which could be done in the home and develop plans of care. As a nurse, I was able to identify not only medical needs but also focused on health promotion and disease prevention. We prevented unnecessary ER visits and hospitalizations as well as promoted quality of life.
My company provided high paying jobs to the Pensacola area. The company saved Medicare and Medicaid money. Our care provided access to care to a “lost” population. Our company was able to refer and take referrals from other companies which depended on our relationship. The business was a win/win for the patients and the community.
Because of the cost of the collaborating agreement and other unfair Florida Laws and the hostage state that I was in I decided to close my practice.
People lost their jobs and patients lost our services!
End this ridiculous practice of mds pimping nps and controlling our profession!
Elizabeth McCormack
April 24, 2019 at 1:21 am
http://www.forbes.com/sites/realspin/2017/03/16/advanced-practice-providers-are-key-to-americas-healthcare-future/
Dan Giraffe
April 24, 2019 at 2:19 pm
Thank you, Governor DeSantis!
As Governor, you put the interests of your constituents first.
You disregarded the ongoing nasty (see above) nursing special interest groups’ anti-physician misinformation and disinformation campaign to make the right decision.
This debate is NOT about whether advance practice nurses can or should practice. They are currently and will continue to provide care to Floridians. No change!! (But you wouldn’t know that reading the posts above.)
The issue is whether the best interests of PATIENTS (not physicians, not nurses) are served by a team-based model of care – APRNs working with physicians. The answer is, yes, patients are best served by the team. It assures high-quality care (and is incredibly cost-efficient).
In the end, the Governor supported patients. You made the right call, Governor!
I will be sure to make sure all my friends know you stood strong for patients.
Latreace
April 24, 2019 at 10:24 pm
This bill is not to divide the healthcare team. It is strictly to allow Advanced Practice providers the ability to do so without additional barriers. This would help to minimize gaps in healthcare access in the state. Currently the citizens in the state of Florida are being cared for by Physicians, Advanced Paractice Registered Nurses and Physician Asistants. Collaboration amongst the providers would not cease by passing of this bill. We would still practice within our scope while providing care. Nothing would be taken from physicians. There are many Nurse Practitioners willing to provide primary healthcare.
Niki
April 26, 2019 at 12:16 am
Excuse me Mr. Governor, but I went through advanced training and completed rigorous coursework to become a nurse practitioner. Yes, we were “nurses” before becoming NP’s, but you cannot paint our knowledge with the same brush as RN’s with associate degrees/Bachelor degrees. We had clinical hours to complete, skills lab, exams, and must I remind you.. WE TOO ARE BOARD CERTIFIED! Please do not demean our profession because we chose the NP route rather than MD or DO route. FYI, I have caught illnesses several other MD’s and specialist have missed. My knowledge isn’t less than because you deem so. We are not “just some nurses” trying to expand our practice for the “fun of it.” We have knowledge, compassion, and quite frankly we give better care than most physicians. We practice on a team based approach which helps close the gaps in health care. If everyone on the team knows what’s going on then the patient has better outcomes. APRNs are a very important part of the healthcare team, patient care, and improving outcomes. I’m not sure why physician groups are so opposed to adding others to the field. It’s not like there aren’t enough sick people to go around. There is a huge need for healthcare providers today, but let’s tie the hands of those with equal knowledge because they lack MD or DO behind their name.. very disappointed in the our Governor!
Martha Oreilly
April 30, 2019 at 11:07 pm
You do not have equal knowledge of you did not go to medical school. Nursing is defined as the alleviation of suffering. Medicine is the diagnosis and treatment of injury and illness. Different skill sets both badly needed. I do not know how to practice nursing fully even though I have watched and helped nurses for years.
Martha Oreilly M.D.
April 30, 2019 at 11:02 pm
If you want to practice medicine there is a tried and true pathway called medical school/residency. It takes a minimum of 7 years. It is not 90% online. It holds students to a national standard of minimal competency. It is far too intense to work part time while doing it. And when you graduate you are fully prepared to practice medicine because you have spent thousands of hours l earning about the processes of the human body then applying that knowledge on direct patient care. Practicing medicine is not easy. the body has not suddenly become simplified.
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