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Like Everyone Else, Our Veterans Deserve Quality Health Care
Thomas M. Anderson, MD
ISMS President
Thomas M. Anderson, MD

As a physician I am concerned about all patients, but as a U.S. Navy veteran, I confess I am particularly interested in making sure all those who have served get the health care they need.

So when I read about a recent proposed rule from the U.S. Department of Veterans Affairs (VA), I did a double-take. In an attempt to address exceedingly long wait times within the VA health system, the proposed rule would allow all four categories of Advanced Practice Registered Nurses (APRNs) to provide services without the clinical oversight of a physician.

I can tell you this: Giving full practice authority to APRNs will not increase the quality of care for veterans. In fact, quite the opposite. Vets would have reduced medical benefits compared to anyone else seeking health care. This is unacceptable – especially for those men and women who have put their lives on the line.

There’s no question that APRNs play a key role on the health care team. However, as you all know, an APRN is required to have five to seven years of training and 500 to 1500 hours of patient care experience, falling significantly short of the education and training of physicians. Most veterans are enduring serious medical challenges, including traumatic brain injuries, which require highly complex medical care. At the end of the day, APRNS are just not a substitute for physicians.

ISMS is strongly opposed to the VA’s unprecedented move. After the VA published its proposed rule at the end of May, ISMS quickly urged the VA and Congress to maintain APRN supervision requirements. ISMS also joined other national specialty and state medical societies to advocate that the VA not move forward with its proposed rule.

If the larger goal is to increase access to care for veterans, why not allow them to see physicians outside of the VA system? This model works well for the TRICARE program (formerly CHAMPUS), which covers military service family members. While we recognize the enormous pressure on the department to reduce wait times throughout the VA health system, removing physician supervision is clearly not the answer. Team-based health care must be physician-led.

The four categories of APRNs that would be affected by the VA’s proposed rule include Certified Nurse Practitioner (CNP); Certified Registered Nurse Anesthetist (CRNA); Clinical Nurse Specialist (CNS); and Certified Nurse-Midwife (CNM).

Of particular concern is that physician-led anesthesia care could be jeopardized in surgical settings. Physician anesthesiologists serve a critical role in providing safe anesthesia care, especially in cases of VA patients who often pose a heightened risk of complications during surgery. The team-based model of care ensures that patients will have access to a physician anesthesiologist if an emergency or complication occurs.

APRNs working outside of VA facilities would remain subject to state or local laws pertaining to APRN scope of practice. Illinois requires physician involvement for nurse practitioners to diagnose, treat and prescribe.

Doctors play an integral and invaluable role on the health care team. The VA must reverse the course of its dangerous proposal. Every veteran deserves the highest standard of care for the sacrifices they made for our country.

I look forward to hearing from you. During my term, I can be reached at DrAnderson@isms.org.

For more on the role of APRNs, access ISMS' medical legal guideline Advanced Practice Nurses' Authority to Diagnose and Prescribe.

This ISMS medical legal guideline is password protected. If you need to request a username and password, contact online support at 888-476-7776 or onlinehelp@isms.org between 8:30 a.m. and 4:45 p.m. After-hours requests are answered promptly the next business day. You may also register online or retrieve your username or password.

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