Renzo Downey
With only a few months left before he retires from the Legislature, Rep. Cary Pigman is pulling all the stops to get non-physician scope of practice freedoms.
This year’s campaign included two Rotunda-filling press conferences, vocal support by House Speaker José Oliva and, Wednesday, a lunch at the upscale Governors Club. But with seven years of general House support only to die in the Senate when it gets there, the question remains whether the Avon Park Republican can shepherd the bill (HB 607) to the Governor’s desk.
“Like anything, we’ve got a 60 day Session, and what happens at the end of this Session is between the Speaker and the President and everyone else in the Legislature,” Pigman said. “I hope that what I’ve done has kind of laid the groundwork, made the argument of why it would be a great idea.”
The Representative’s proposal would open the door for advanced practice nurse practitioners (APRNs) to offer some health care without needing a physician’s supervision. But that supervision amounts to signing a permission slip, says David Hebert, CEO of the American Association of Nurse Practitioners (AANP).
“Expanding the availability of medically-provided primary care is the most immediate affordable high quality solution that Florida can get at this moment,” Hebert told nurse practitioners at the Wednesday lunch.
Nurse Practitioners (NPs), a subset of 270,000 APRNs nationwide, make up 25% of rural health care providers, said AANP President Sophia Thomas.
“Certainly across the country, we’re seeing with the removal of these legislative barriers, NPs are able to practice within the full extent of their education and training and open up spots so that access to care is improved,” she said.
In October, President Donald Trump signed an executive order in part reducing supervision in Medicare and Medicaid treatment. Proponents of the lessened restrictions see the order as signaling support for their scope of practice efforts.
With Oliva’s backing and support from the U.S. Secretary of Health and Human Services Alex Azar, Hebert believes the wind is at their back.
“You’ve got all these groups coming together saying, ‘wow, we want to be a part of this too,” he said.
But the bill’s last hearing took place three weeks ago. It awaits a meeting in the House Health & Human Services Committee. And with no Senate companion measure, the effort rides on his bill.
Last week, Pigman said 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.
But some physicians took offense to that accusation. The Florida Medical Association argues the bill risks public safety and would dismantle team-based health care.
Pigman doubled down Wednesday, saying that in the absence of evidence against APRN independence, he sees institutional sexism as holding back APRN independence.
“Look at those places that allow independent practice. Look at what their outcomes are like, and then look at a state that has supervised practice and see if there’s any difference in outcome,” Pigman said. “There is no difference in outcome.”
And the American Academy of Family Physicians, in a letter to Azar, said the Trump administration’s order would reduce patients’ quality of care over a “political” decision.
“No patient, especially those in rural and underserved areas, should be relegated to a lower level of care by clinicians with lesser training by virtue of their ZIP code,” the letter said.
However, underserved areas are among the locations Pigman believes need APRNs the most to address extended wait times to see a physician.
2 comments
Paulette Perlowin
February 9, 2020 at 5:41 pm
Mr. Downey, thank you for covering this topic. I am a Psychiatric Nurse Practitioner. I see a Medicaid patient population. My patients suffer while waiting my supervising psychiatrist’s signature on a piece of paper to begin or continue accomodations shown needed by psychoeducational testing so the child can get the full education taught to his/her learning problem. This is only one delay of many which I am fully capable of ordering that causes these children to lose valuable education time in school. Research shows the value & successful treatment provided by APRNs so I won’t go into details. The problem is not one of treatment outcomes but of money. Physicians in Florida have developed an income stream based on Nurse Practitioners’ work. They charge fees to ‘supervise’ NPs often without ever seeing the patients or needing to sign a chart or order. The physicians collect this money but NPs do all the work. Physicians don’t need malpractice insurance in this state but NPs are required to carry it, so there is essentially no liability involved for the physician. My point brings this argument back to money. If physicians are so very honestly concerned about patient safety & having continuing team collaboration, then de-monetize this process. Require all physicians (general practice and specialties) to ‘supervise’ a given number of APRNs in a given time frame and let’s see how this progresses. My suspicion is that without money flowing into physicians’ pockets, they will walk away from wanting to supervise us at all. There are likely a few outliers that prove me wrong – I can only hope so! I work in a low-income specialty for physicians, so there is a shortage of Psychiatrists; I respect, admire & adore my physician colleagues. I believe they feel the same about me. Please, Florida citizens, contact your Florida Representatives and Senators and encourage their support of CSHB607. Florida need NPs desperately in certain areas and certain specialties!
Linda Washington-Brown
February 13, 2020 at 11:36 pm
Mr. Downey,
I am a certified Advanced Practice Registered Nurse (APRN), in practice since 1989. Over these years, I have worked collaboratively with many physicians, of which we held mutual respect for our education and training. During most of my APRN practice, the physician was not present in the underserved or rural areas, but was available if needed.
Here is an opportunity for APRNs to meet the needs of our Floridians. It is time for health care professions to come together and allow APRNs to work to the full extent of their education and practice.
Linda Brown, PhD, EJD, APRN-C
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