A Senate budget panel approved Tuesday two health care scope of practice measures, including a pilot version of a House Speaker José Oliva priority.
The Senate Appropriations Committee gave the final thumbs up to a bill (SB 1676) by Sen. Ben Albritton allowing for greater advanced practice registered nurse (APRN) freedoms, similar to the Oliva-backed House version (HB 607). A separate bill (SB 1094) passed by the panel, and filed by Sen. Manny Díaz Jr., would let pharmacists treat patients for chronic medical conditions in collaboration with physicians.
Albritton’s bill establishes a pilot program overseen by a new council created under the Department of Health. An amendment to the Wauchula Republican’s bill dropped the threshold for entry to the pilot program to 2,000 hours of supervised practice over the last four years, down from 10,000 hours over the previous six years.
Unlike Avon Park Republican Rep. Cary Pigman‘s House version, slated for a vote in that chamber Thursday, physician assistants could not apply to the pilot program. Additionally, Pigman’s version is not a pilot program.
Albritton’s bill would also establish a physician student loan repayment program offering up to $50,000 awards to up to 50 qualifying physicians each year. However, that provision awaits a future appropriation.
The Senate measure received a 16-4 vote.
And Díaz’s bill would authorize pharmacists to initiate, modify or discontinue drug therapy while working under supervisor agreements. Pharmacists could not diagnose conditions under the proposal.
Under the bill, pharmacists could serve ambulatory surgical centers, inpatient hospices, hospitals, addiction treatment centers, ambulatory care centers and nursing homes. Chronic conditions are defined in the bill as including arthritis, asthma, chronic obstructive pulmonary diseases, type 2 diabetes, HIV, AIDS and obesity.
That measure passed the Senate panel 12-8.
The Florida Medical Association opposes both bills. But Oliva has made reducing health care regulations a major priority of his tenure as speaker.
March 4, 2020 at 12:19 am
I dont find SB1094 to be an acceptable or fair choice for Advanced Practice Nurses (APN) to provide care. It is restrictive, minimizes & marginalizes the rest of us APNs, scrutinizes us needlessly, & neglects the needs of needy Floridians who can wait months for appointments. I have watched these scope of practice initiatives closely; I’m an APN. The10-year pilot study in SB1094 only allows primary care APNs to work only in a very few & limited select areas of Florida, & effectively prevents the rest of us, for 10 years, from working autonomously (this is our more accurate term for Independent Practice) in specialties that also may be in very short supply. HB607 was sponsored by wonderful Representative Dr. Pigman & appropriately allows APNs to provide effective safe & needed care at an autonomous level of professional practice. By implementing that 10-year pilot study, the rest of us are prevented from seeking this level of practice. However, & just as important, physicians will continue to charge APNs fees or other compensation for us to be able to work at our profession. Not every APN will meet criteria to be awarded the privilege of Autonomous Practice/Independent Practice; also not every APN will even want to apply & have this level of responsibility. Those of us that desire this privilege to give back to Florida should be allowed & not have to wait 10 years! HB607 & HB7053 (contains most of HB607) are much better choices for Floridians as well as APNs.
March 5, 2020 at 12:41 am
So did you enter the profession hoping for it to change or did you just not realize what you were signing on to? If autonomy was your biggest priority why not go to medical school?
March 5, 2020 at 3:04 am
(Dr?) Sirius: I don’t believe I said autonomy was my biggest priority; it isn’t. I didn’t WANT to go to medical school, I wanted to be a Nurse. Might surprise you, but there are nurses working at lower levels than APN practice who aren’t supervised by anyone, including case managers, screening clinics, employee health, infection control, education, expert witness…etc. When I became a Nurse, the NP career choice was still in its childhood. I grew in career options as nursing careers did. Hasn’t medicine developed over the years? Outpatient procedures that used to be done only in hospitals & only by surgeons moved to outpatient surgery centers & now some in physician offices; alcohol & drug detox used to be on inpatient units, now also at residential programs & outpatient detox programs; etc. Excellent patient care for Floridians was my priority, something I’m deeply committed to as a native Floridian. I was a Registered Nurse for about 16 years, & an APN now for about 15 years. In 31 years I’ve seen lots of health professionals approach patient care with various good & bad attitudes & respect for clients. 95% of my patients say they’d rather see me than a physician; many refer to me as “you’re my doctor.” I ALWAYS correct them, say how proud I am to be a Nurse & wouldn’t want to be a doctor & thank them for the compliment. Then they often say “I know but I think of you that way anyway.” I worked long & hard for the degrees I have, likely as many if not more years than a physician. I have an AA, 2 Bachelor’s, 2 Master’s, a Post Master’s Certificate, & a DNP. (The other 5% of my patients say I spend too much time with them!) I don’t claim to have the education or practice hours or experience of a physician – I’m too proud of what I do have. My patients call me by my first name, never ‘doctor,’ however I DO use my title when introduced at professional venues & on letters. I hope this narrative answers & addresses your points. I have a few more points. There are a number of medical specialties in short supply in Florida in addition to rural primary care & specialties: psychiatry; urology; cardiology; neurology; & others. My patients wait months to see some of these specialists. APNs could easily fill this void at the same quality of treatment with successful outcomes as physicians. This is supported already by a huge volume of evidence. Last point: The medical profession has created a cottage industry off the labor of APNs. There is no requirement now for a doc to look over my shoulder, look at my work, cosign my notes or orders, or see my patients. Docs aren’t required to carry malpractice insurance but I am. Some schools now require my physician’s signature on forms; this needlessly inflates the time for services to begin for some children I treat, when I’m well able to select & order these treatments & services. I would have the ability to seamlessly order things like this quickly for my patients if I had autonomous practice. I also want it known I absolutely adore & hugely respect the physicians I work under now & in the past; they are amazing clinicians, professionals & colleagues & I’m thankful they have always supported me & other APNs on our teams, & I’ve learned a lot from them that I ‘pay forward.’ But the money thing… On one hand physicians say APNs need a paper called a Protocol from a physician to work. APNs are charged by physicians to obtain this; it’s renewed at least every 2 years. Physician’s claim APN practice is unsafe, dangerous, ineffective & need supervision but have absolutely NO evidence or research to demonstrate support for these claims. The money flow is very significant & is not easily given up by physicians; my theory is this money is the draw. If I’m wrong & there is true (though misguided) belief APNs provide poor patient care, then de-monetize the process, legislate that no physician can collect any kind of compensation from APNs but must supervise, for example, 5 APNs yearly. Then let’s see how fast physicians change their mind. Thank you.
March 6, 2020 at 5:55 am
THE REAL ISSUE IS THAT WE HAVE BEEN ELECTING PEOPLE WHO SEEM NOT TO UNDERSTAND HOW, OR CARE TO CREATE BILLS DIRECTED AT MAKING A CAREER IN MEDICINE MORE APPEALING, LESS EXPENSIVE, AND FREE OF CORRUPTION.,.
March 6, 2020 at 10:05 am
As a patient, I’m really concerned that this bill will have serious unintended consequences including physicians choosing not to practice in FL anymore, increasing health disparities, and the select hiring of less trained professionals by corporations looking to save a dollar at the cost of public health. Further, there is nothing preventing NPs from practicing in rural areas already AND in states that have passed similar legislation, they don’t even go to rural areas. The comment from the NP above that they don’t want to be restricted to rural areas is pretty telling. I want to see a real doctor for my care, someone who is fully trained and capable to practice medicine independently. I see this bill creating a two-tiered system where the rich will be able to still see real doctors and the poor will be forced to go to NP clinics where there won’t even be a doctor supervising them anymore
March 6, 2020 at 10:16 am
Patients need safe, effective healthcare led by physicians; not substandard healthcare provided by non-physician providers. Patients also deserve to know the level of training of all health care professionals on their team.
Scope of practice should be commensurate with the level of training of each member of the healthcare team. Declaring equivalence between physicians, nurse practitioners, and physician assistants is extremely dangerous and misses a very important fact: physicians have over 15,000 hours of structured, carefully regulated education and training, including medical school, residency, and fellowships. NPs and PAs do not. Physician training amounts to up to ten times the training of nurse practitioners and physician assistants.
Every health care decision has a consequence, and the lack of training of non-physician providers (NPs and PAs) presents an enormous risk to patient safety if they are left to practice independently.
Note that, to ensure patient safety and quality of care, attending physicians supervise residents (physicians in training) at all times; yet these resident physicians already have several times more cumulative training than the nurse practitioners and physician assistants who are lobbying for independent practice.
Bills such as HB 607 and SB 1676 present an enormous risk to patient safety. While nurse practitioners and physician assistants are valuable members of the health care team, they are not qualified to practice independently. Do patients deserve access to lesser, “just OK” care provided by non-physicians? No. Patient-centered care involves physician-led collaborative teams.
This bill, if it is passed, will put FL citizens in serious danger. At the very least, any NP or PA who out state government allows to practice medicine unsupervised should be held to the same standard as physicians, including carrying the same malpractice insurance limits as physicians ($1mil/$3mil) and oversight by the Board of Medicine. As the bill is written now, it allows inadequately trained mid-levels to practice medicine without a medical license and it also allows them to cause serious harm to patients without anyone actually holding them responsible for their mistakes.
Don’t allow these politicians to be bribed into putting the public in danger. Any representative who votes in favor of this bill should be held responsible for the harm that will inevitably be done to patients by unsupervised, inadequately trained midlevels as a result of it.
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