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VOL. 37 | NO. 25 | Friday, June 21, 2013




Tennessee doctors, nurses square off over care

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NASHVILLE (AP) - The growing demand for medical care that is expected to accompany the full implementation of the federal health care law in January is adding urgency to a Tennessee debate over whether nurses should be allowed to provide more independent care to patients.

Nurses currently see patients in a variety of settings ranging from private practices to retail clinics, but they want to remove a layer of supervision from physicians. Doctors' groups oppose giving nurses more independence. A legislative fight is on the horizon.

"We're in the ring," said Gary Zelizer, who lobbies on behalf of doctors for the Tennessee Medical Association. "We're warming up, but it's coming."

Sharon Adkins, the executive director of the Tennessee Nurses Association, said in an email that her group is "in full support of removing practice barriers and support full practice authority for all health care professionals."

Adkins said advance practic e registered nurses, or APRNs, "give as good or in some cases better care than physicians."

"As the (health care law) rolls out and more Tennesseans will be seeking primary care, nurse practitioners will be key providers of that care," she said.

Zelizer argues that nurses face no insurmountable barriers to providing services.

"I would charge them with being able to demonstrate that they can't find a physician that's willing to sign off on protocol to let them do any primary care service," he said. "That's not a problem in this state.

Zelizer said giving nurses more independent authority over medical care would do little to ease the shortage of medical care in rural areas of the state.

"When you overlay where physicians are located and where nurse practitioners are located, generally speaking it's in the same geographic locality," he said.

Instead of giving nurses more independence, doctors would prefer there to be greater oversight by docto rs.

"We support a health care team, but you've got have a leader of the team," he said.

Republican state Senate Finance Chairman Randy McNally of Oak Ridge, who is a retired pharmacist, said lawmakers are gathering information in advance of the coming debate between nurses and doctors.

"There has been some tension over the independent practice issue," he said. "There are probably some things that could be done."

"I think we've worked together with the physicians and it's been a cooperative venture," he said. "But the physicians want to be assured that their patients are getting quality care."

The state had 13,307 active care physicians in 2011, or 210 doctors for every 100,000 Tennesseans, according to data compiled by Association of American Medical. Those figures rank Tennessee near the average nationally.

The study found that the number of Tennessee students enrolled in medical or osteopathic schools grew by 41 percent between 2000 and 2 010, the 10th highest rate in the country.

Zelizer said clinics in retail pharmacies or urgent care centers, both of which are largely staffed by nurses, should not be considered a solution to long-term care shortages.

"The concern is the issue of continuity of care," he said. "It's one thing to take a child in when you're out of town and need something real quick, but there's too many people who rely on the retail clinics for their routine care.

"And that eliminates the possibility of having somebody oversee that care."

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