This is a battle that has long been in coming… And, the Veteran’s Administration (VA) is making it happen- now.

The VA is proposing to let PAs (physician assistants) and nurses with advanced training practice medicine within their own facilities without oversight by a physician. This will be true even in states where the laws stipulate such oversight is required.

Of course, the physicians are up in arms. We are talking about taking away a big chunk of potential earnings. Some 60 groups have sent in their concerns to the VA, claiming their proposal will “eliminate physician-led team-based care” within the VA. Would you be surprised that 40 nursing groups responded to the proposal claiming it will “further facilitate timely delivery of high-quality health care”?

This is going to be a bigger issue, as more folks get covered by Obamacare (PPACA is the proper acronym). Because it will be clear that physicians are in short supply in many areas. The VA, which operates some 1700 hospitals and clinics in the United States- and even with a 40% increase in its budget- is barely keeping up with mental-health and disability issues for our veterans.

At the end of 2013, the VA had already decided to let supervising physicians (who now are called “collaborating” physicians) decide as to how much autonomy a PA is entitled. Not surprisingly, the American Academy of Physician Assistants (AAPA) termed this a model of flexibility.

But, now, the 6135 advanced-trained nurses at the VA (nurse practitioners, nurse anesthetists, nurse midwives, and clinical nurse specialists) are now considered to be independent practitioners. There will no longer be any need for physician supervision.
The Institute of Medicine in 2010 proposed that change already. Since these nurses already have PhD’s or Master’s Degrees, pass certification exams, and have been operating independently for years in the military or VA systems, this is really just a recognition of what has been really happening without any change in policy.

Health Affairs in that same year reported (a study) that patient outcomes were not affected whether it was a nurse or physician anesthetist involved (with or without supervision). It certainly saves money for the patient (and/or insurer), as reported in Nursing Economics.

Now, we have Congress getting into the act. Representative Harris (R, MD) believes the VA is acting hastily, that it’s not wartime, and is inviting physicians to express their views. Oh, and Dr. Harris is a physician anesthesiologist….

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