Death by White Coat
In the shadows of America's healthcare system, a silent killer claims lives with alarming efficiency. In 2022, 82,998 Americans fell victim to opioid overdoses, thrusting our nation into an epidemic that has authorities scrambling for solutions. The black market obscures these drugs, complicating efforts to trace and halt their devastating impact. What is particularly disquieting is the revelation that opioids, leading to addictions and death, aren't just products of illicit trade. They also emerge from the trusted hands of licensed nurse practitioners (NPs), some of whom turn prescriptions meant to heal into unwitting instruments of tragedy. A recent case in Alaska saw a former NP sentenced to 30 years for illegally prescribing opioids, contributing to five deaths. This harrowing reality prompts us to question not just how it happened, but why our healthcare safeguards failed, allowing tragedy to unfold unchecked.
This is just one example of a morally corrupt and unsupervised NP. Though there are more stories like this, it would not be correct to assume that all or even most NPs are morally corrupt. But unlike doctors, nurses, or even physician assistants, NPs have a unique position in America's healthcare system. In 32 of the states and in the District of Columbia, NPs have what is called Full Practice Authority, meaning that they can work as practitioners without supervision. Practically, nurse practitioners can diagnose a patient, order tests, prescribe medications and operate their independent practices. In 12 states, NPs have Reduced Practice Authority, meaning that they need a physician's supervision to prescribe medication or run their practice. The remaining states have Restricted Practice Authority, which means that they must work under the direct supervision of a physician at all times. Alaska is a Full Practice Authority state.
There are additional restrictions that can vary from state to state. In New York (which is a Full Practice Authority State), NPs have to complete 3,600 hours of experience before being able to run their practices fully autonomously, which comes out to just two full years of working.
Compare this to doctors who have to go through four years of medical school and then three to seven years of residency before they can work autonomously. This leads to an obvious issue: NPs can earn their degree in as little as one year (and in some schools without any clinical hours), after only working as a nurse for one to two years. Not to mention the schooling itself is significantly lighter than anything a PA or medical student has to go through. An NP can attend school part-time, online, and finish their degree over five years by just taking a few online night classes every semester while they focus on their other day-to-day tasks. It is safe to say one can become a fully licensed and independent practitioner with relatively little schooling and experience. Yet, over half of the states allow them to act as doctors by wearing white coats and making independent decisions for their patients.
Demand for doctors and physicians has been ever-increasing since the passing of the Social Security Amendments of 1965. With the development of Medicare and Medicaid, millions of Americans gained new access to healthcare. The need for primary care increased and subsequently, the need for doctors to see all these new patients. The Affordable Care Act, signed into law by President Obama in 2010, had a similar effect by opening up Medicaid to millions of Americans. By allowing NPs to act as doctors, states can supplement the rising demand for doctors through a relatively quick and affordable path since NPs are paid significantly less for the same work. NPs play a vital role in today's healthcare system, and without them many Americans would be left without access to any primary healthcare. But patient safety has to be taken into account just as seriously and for states to allow NPs to launch their own businesses and prescribe Schedule II — V drugs without any supervision is reckless and dangerous.
A potential solution requires a three-pronged approach. First, NPs must be required to attend full-time school in person like other medical professionals. Their focus must be entirely on medical education; they cannot be distracted and take classes haphazardly. Second, all states should require a minimum of four years of experience as an NP with oversight before allowing them to operate their own clinics. And finally, patients should be informed when they are seeing an NP rather than a doctor, because most Americans do not know the difference. If NPs are banned from wearing white coats and make sure to explain to the patient that they are not doctors, patients will be more likely to critically evaluate the medical advice they receive and seek a second opinion if necessary.
This latter approach would directly confront the issue at hand by ensuring a more trained and experienced NP system and also ensuring a safer medical experience for patients. The American healthcare system needs a boost of personnel and NPs can surely be the answer to the problem, but this process cannot be rushed. All consequences need to be considered and safeguards must be put in place before nurse practitioners are allowed to act as doctors without the same training and experience as other white coats.
Photo Caption: But unlike doctors, nurses, or even physician assistants, NPs have a unique position in America's healthcare system.
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