Cary Pigman corrals nearly 200 nurse anesthetists to support nurse independence

Gov. DeSantis picks 63 for Judicial Nominating Commissions

Protecting tourism development, cleaning Lake Toho top Kristen Arrington’s 2025 priorities

Joel Rudman files legislation to require Florida businesses to take cash

The bill is one of House Speaker José Oliva's top priorities.

Nearly 200 nurse anesthetists filled the fourth floor Rotunda at the Capitol Tuesday in support of a bill for increased nurse independence.

House Speaker José Oliva this year has thrown his support behind the bill (HB 607), possibly giving Rep. Cary Pigman the push needed to shepherd it through that chamber. However Gov. Ron DeSantis and the Senate aren’t as keen on the proposal. No Senator has filed a companion bill this year.

Pigman joined the Florida Association of Nurse Anesthetists (FANA) to urge support for his bill. Florida has more than 34,000 licensed advanced practice registered nurses (APRNs), including more than 5,400 Certified Registered Nurse Anesthetists (CRNAs,) who work in all practice settings including hospitals and in other health care facilities and offices.

Currently, APRNs and physician assistants require supervision from a doctor. But the Avon Park Republican’s proposal would give those practitioners more independence.

“I think historically the historical state laws didn’t contemplate the sophistication of the education and training that you all have received,” he said.

Pigman, a medical doctor, is one vocal physician pushing for the proposal. But the Florida Medical Association and other groups are concerned the bill would exclude physicians from some health care procedures.

For Pigman, his legislation in part addresses gender income inequality in STEM careers. Men made up 70% of physicians who recently re-registered while women represent 85% of APRNs.

Dismissing APRNs as unqualified and in need of supervision “is on its face sexist and reprehensible,” he said.

Studies show there is no change in the quality of the care provided by physicians versus nurses, according to Pigman and FANA president José Castillo.

“I would say, when you look at what their experience is on paper, what their training is, it’s quite extensive and exhaustive,” Pigman told reporters. “And when you look at studies that compare the outcome between those two categories, nurse practitioners and CRNAs and physicians, our outcomes are equivalent. “

On Wednesday, APRNs from the Floridians Unite for Health Care coalition stood on the same floor to support the bill. Oliva was supposed to join Pigman for that press conference, but the Speaker pulled out because of a scheduling conflict.

Speaking to reporters after Wednesday’s House session, Oliva lamented the fact that he couldn’t attend the conference. But he will have plenty to say in the Session’s remaining weeks.

“It’s important that people see there’s a great deal of other folks that this affects very directly and also to hear their voices,” he said.

The bill passed the House Health Care Appropriations Subcommittee this month. It now awaits a hearing in the House Health and Human Services Committee before going to the chamber floor.

Republican Sen. Jeff Brandes, who filed the bill’s Senate counterpart last Session, said he supports the legislation and expects it to gain traction in the Senate. Last year, the House took its major wins on health care but punted on APRN independence.

But Oliva on Wednesday remained confident the bill can pass both chambers without needing to compromise; he’s got the support as-is.

“I feel strongly that the Governor and the President of the Senate will give it its fair shot and we’ll look at the facts for what they are,” Oliva said. “And I think the facts are on our side.”

Post Views: 1,370

A concerned citizen

January 30, 2020 at 1:58 pm

So Florida grants a scope of practice to a group with less education and training that is congruent with those that the state requires to have far more education and training (physicians). In fact, the scope of practice is actually far greater since there is no law or regulation preventing subspecialty changes, I.e. a CRNA can go from practicing general anesthesia to running a chronic pain clinic without any additional training and expect no intervention from the State Nursing Board. You can practice neurology one day, cardiology the next. Next the NP movement demands equal pay from federal and state payors (Medicare and Medicaid) which has happened in each state that has granted FPA. Then they demand equal payment from private insurers (United and Blue Cross/Blue Shield). The patient never sees the lowered costs because they are pocketed by the employer of the CRNA or NP and not passed along to patients. Now a cardiologist is paid the same as a nurse practitioner who is “practicing in cardiology”. No worries, the NP soon declares that he is a “nurse cardiologist” which confuses patient’s into thinking that they have the same training as a board certified physician cardiologist. Don’t worry, the term “board certified” isn’t a trademark so everyone will call themselves “board certified” without ever specifying which board and or what amount of testing was required to acquire that board certification. Also, cardiologist isn’t trademarked or really able to be trademarked so really anyone in Florida could hypothetically call themselves a Cardiologist. There is no legal charge against them for the unlicensed practice of medicine, because they are practicing nursing which is now a completely legally undefined term but obviously encompasses all of the practice of medicine “full practice”. The patient sees ZERO cost savings, but notices that they no longer can book appointments with physicians whom they previously trusted as easily. When they ask for a physician they are frequently unable to acquire one because Congress doesn’t act to increase residency training positions for physicians, because “who needs physicians?”. When they are injured, the patient finds out in the court system that the standard of care is in fact different as physicians are not able to testify as to what the standard of care should be. In effect, those who understand medical science and best practices best are forbidden from testifying as to what should have been done. Now as a patient you have been deceived, injured, and prevented from acquiring compensation for the injury and you have not received one dollar of cost savings. If you don’t believe this, look no further than the use of “nurse anesthesiologist” by a Florida CRNA which has already occurred and is a deliberate attempt to confuse patients for personal prestige and increased salary. There are so many unaddressed issues by this poor piece of legislation that it appears to be thought out by someone completely unaware that any of these issues exist.

8 comments

Nicole
January 29, 2020 at 9:31 pm

This completely invalidates the women’s rights issue of equal pay. Shame on Cary Pigman for trying to use this argument to bolster support. This is the equivalent of saying that the only reason a female burger flipper makes less than a male doctor is because of their sex. This devalues all the true claims of unequal pay that are occurring on a large scale.
A concerned citizen
January 30, 2020 at 1:58 pm

So Florida grants a scope of practice to a group with less education and training that is congruent with those that the state requires to have far more education and training (physicians). In fact, the scope of practice is actually far greater since there is no law or regulation preventing subspecialty changes, I.e. a CRNA can go from practicing general anesthesia to running a chronic pain clinic without any additional training and expect no intervention from the State Nursing Board. You can practice neurology one day, cardiology the next. Next the NP movement demands equal pay from federal and state payors (Medicare and Medicaid) which has happened in each state that has granted FPA. Then they demand equal payment from private insurers (United and Blue Cross/Blue Shield). The patient never sees the lowered costs because they are pocketed by the employer of the CRNA or NP and not passed along to patients. Now a cardiologist is paid the same as a nurse practitioner who is “practicing in cardiology”. No worries, the NP soon declares that he is a “nurse cardiologist” which confuses patient’s into thinking that they have the same training as a board certified physician cardiologist. Don’t worry, the term “board certified” isn’t a trademark so everyone will call themselves “board certified” without ever specifying which board and or what amount of testing was required to acquire that board certification. Also, cardiologist isn’t trademarked or really able to be trademarked so really anyone in Florida could hypothetically call themselves a Cardiologist. There is no legal charge against them for the unlicensed practice of medicine, because they are practicing nursing which is now a completely legally undefined term but obviously encompasses all of the practice of medicine “full practice”. The patient sees ZERO cost savings, but notices that they no longer can book appointments with physicians whom they previously trusted as easily. When they ask for a physician they are frequently unable to acquire one because Congress doesn’t act to increase residency training positions for physicians, because “who needs physicians?”. When they are injured, the patient finds out in the court system that the standard of care is in fact different as physicians are not able to testify as to what the standard of care should be. In effect, those who understand medical science and best practices best are forbidden from testifying as to what should have been done. Now as a patient you have been deceived, injured, and prevented from acquiring compensation for the injury and you have not received one dollar of cost savings. If you don’t believe this, look no further than the use of “nurse anesthesiologist” by a Florida CRNA which has already occurred and is a deliberate attempt to confuse patients for personal prestige and increased salary. There are so many unaddressed issues by this poor piece of legislation that it appears to be thought out by someone completely unaware that any of these issues exist.
Teresa
January 30, 2020 at 1:59 pm

I am a female physician and am highly offended that Pigman is making this to be about sexism. I am part of a large group of women physicians who are opposed to independent practice by NPs, CRNAs and PAs. It has nothing to do with sex but has everything to do with patient safety. The NP lobbying groups have convinced legislators they provide equal if not better care than physicians. This is based on old, poorly designed studies that at best show there isn’t enough data to even make that claim. Sorry, but an NP who got an online degree in 18 months and 500 hours of shadowing preceptors (and in many cases the NP student has to find their own preceptor without any help from the online degree mill school they attend) is in no way equal to the rigorous, very standardized, hands-on education physicians undergo through 4 years of med school and 3-7 years of residency training where they spend 10,000 hours or more on direct patient care. This independent practice agenda is a huge social experiment gone amok and many patients are already dying and suffering because of it.
- Dr. Anonymous
  January 30, 2020 at 3:48 pm
  
  https://www.google.com/amp/s/www.medicalmalpracticelawyers.com/emergency-room-malpractice-2/6-1m-oklahoma-medical-malpractice-verdict-for-death-of-19-year-old-in-er/amp/
- Elle
  January 31, 2020 at 5:39 pm
  
  I also find this highly offensive. As a female
  Physician, I do not support independent practice and I do not need to play the gender card to equal results. I received and MD and completed a residency. After 15,000 hours of education and training, I am a practicing physician. I do not need to qualify that with my gender. How will we controls scope of practice? An NP gets an online degree in FNP and bounces around between dermatology and cardiology no training. It’s utterly frightening. And I would like to ask all of these legislators, who will take care of them in their greatest time of need or in a life threatening situation? I would also like to ask these legislators, many who are attorneys, if a paralegal works for 10 years and gets an online masters degree in legal studies, will they be able to practice law without an attorney. Absolutely not. And what about standard of care? Since they claim they are as qualified as doctors, will their standard of care be that of a doctor? Or will there be a lower standard of care; that is, nursing standard. Legislators, if you choose the latter, then you are telling your people that it is ok to be cared for by someone who offers a lower standard of care. Terrible poorly thought out piece of legislation and once again or representatives are pushed by the special interest groups
Taiba
January 30, 2020 at 3:47 pm

As a female physician, the claims he makes in regards to sexism are completely untrue. Most medical schools are now at least 50% female. Aside from this, patient safety is at the heart of the matter. Non physician providers play an important role in healthcare however they are not the answer to physician shortage. The oversight of non physician providers by physicians was put in place in order to protect patients from harm from providers with much less experience and knowledge. I never thought that our legislators could be so ignorant on such topics and it makes me wonder what else they are ignorant on. I am so upset for my patients who don’t know any better and my own family who will suffer from legislation such as this.
Vanessa
January 30, 2020 at 8:28 pm

This guy owns 4 urgent cares. Think of how much $ he can make with fpa…patient is billed the same amount whether or not he is seen by a doc vs an np. All you will see across the state is pigman Urgent Care staffed by an NP (who ultimately will just dump the patient on the ED, letting the patient pay twice for the same complaint).

This bill has nothing to do with “access to care” and everything to do with people like pigman and huge health care systems making more money at the cost of society’s health. There is literally no study that has ever concluded that access to poor care is more beneficial than access to no care. In fact, access to poor quality care is worse than access to no care at all (reference: the Lancet). It is so, so sad that the only people who will have access to MDs are the wealthy – a lot of MDs are waking up to realize the raw deal employment represents- while everyone else will have to see a nurse or a PA for care.
R. Rao
February 5, 2020 at 9:12 am

Dear Physicians/Patients: This is a slap on the face of our patients health care. When we are proud of rendering the highest medical care in the world for our patients, it shows how few greedy, for their own benefit, tears down very essential thread of our medical care into pieces. I have worked in three continents and I have ever saw a nurse or PA working on their own and saying to the patient that they are equivalent to the doctors. This is a very low in our medical history of our country. The physicians has lost their SPINE!!!. We are getting medicine made OUTSIDE our country without informing physician/patients about their country of Origin (COO) and making significant profit by the pharmacy. The EMR/Insurance companies/telemedicine entities outsourcing our jobs and exposing patient’s data for ransomeware/Hippa violation. What happened to our physicians body who are supposed to be the gatekeeper of our health care?. “God Bless American Physicians and our Beloved patients.”. This is a wake up call for all physicians to stand for what is right and to protect our patients health. Enough is enough. No wonder there is no interest in becoming a doctor by our younger generation.