The recommendation that research is needed “to develop effective systems of consultation” leads me to question whether the authors of the ACP document have ever observed a nurse practitioner in action—or, for that matter, any of the other professionals with whom they consult and collaborate in their everyday practice. There are well-established systems already in place, and HMOs, college health services, and community health centers are shining examples. In all of these settings, the health care team functions as an efficient, effective body, offering patients excellent care and access to the professional most appropriate for their management and treatment. The research we really need is on how to replicate those successful systems and make them the paradigm for primary care throughout the United States.
The best health care system is one in which all the providers share the ultimate responsibility for the care provided. Each professional has the obligation to function to the fullest extent of his or her scope of practice and capability. The days of a hierarchical system in which the physician is the “captain of the ship” are gone. The idea that one profession can constrain another profession is ludicrous. In this regard, it appears the ACP agrees that the nursing discipline is the body to be charged with developing scope-of-practice statutes and regulations. I encourage the ACP to work with other physician groups to embrace this notion and to refrain from interfering with legislation that guarantees NPs the ability to function to the fullest extent of their profession.
I will be interested to read the ACP policy on physician assistants. I was appalled that in the current document, the authors referred to my PA colleagues in the possessive (“physician’s assistants”)—but I will leave it to PA Editor-in-Chief Randy Danielsen to deal with that faux pas.