First and foremost, thank you for being on the frontline and the front door of the healthcare system even before the challenges of the COVID-19 pandemic. The challenges of the pandemic have brought to light what you’ve been doing all along – taking care of anyone, anytime, and anyhow.
Understand the ACEP nationally and the Louisiana Chapter specifically are here to help emergency physicians in our state during these challenging times and beyond. We have ongoing issues with reimbursement, liability reform, and physician “wellness.” (I’ve never liked the term “burnout,” as it seems to place the blame on the physician rather than the milieu leading up to it.)
Right now, the biggest threat to our patients our scope creep bills such as HB 495 which would allow for independent practice of nurse practitioners. Similar bills are being introduced for the independent practice of physician assistants. Acknowledging that NPs and PAs are important physician extenders and members of the physician-led healthcare team, we cannot let this happen. These extenders graduate with less training, a fraction of your clinical contact hours, and are able in some instances to “switch specialties,” rather easily. Imagine if you wanted to switch as a physician from emergency medicine to orthopedic surgery next month. Some of this situation is admittedly our fault. As physicians we have held our heads down and kept going with the idea that taking care of patients was the highest priority. We have left the politicking and lobbying to others. We have contributed to PACs at a much lower rate than nursing and trial attorneys.
What can we do? In terms of the bill, you need to contact your Louisiana State Senators immediately. Go to https://www.legis.la.gov/legis/FindMyLegislators.aspx to find your state senator. Call them by phone and include the Chairman of the Health and Welfare Committee on your list. Encourage your friends and family to do so. Engage local media to tell this story to the public as well. The overwhelming majority of the public want a physician involved in their medical care – despite what other contrary messaging may be. Do not belittle NPs and PAs – acknowledge them as important part of the healthcare team when supervised by physicians. Do not emphasize the unfairness (it is) of this situation nor the threat to your professional scope (it is), but rather focus on the threat to the safety of our patients and their constituents. As doctors, we like to emphasize data and that’s fine, but make sure you include stories in your messaging as well. Politicians respond to stories. “Let me tell you about a problem one of my patients faced who happens to be a constituent in your district…”
We need a call to action for this situation as it is urgent. We also need to formulate backup plans should this pass out of the committee to senate then out to the governor’s desk. Other states have employed laws that require written disclosure that their “provider,” is not a physician.
We stand with you on this. We’re fighting this. And I look forward to your engagement regarding HB 495. If you need to contact us, please do not hesitate to do so.
Mike Smith, MD, MBA, CPE, FACEP
President, Louisiana ACEP