Patients Deserve To Have a Physician Oversee Their Care

Patients Deserve To Have a Physician Oversee Their Care

I am sure that you, like I, regularly hear from patients regarding their challenges associated with receiving timely access to care.  It is a significant problem that must be addressed.  Certainly, the burdens associated with practicing in New York make it hard to retain physicians.  But as healthcare leaders, we must work to help our patients get the services they need.

Unfortunately, some mistakenly think the solution is to replace physicians with PAs and NPs and remove the important oversight we provide to protect patients.  Last year, the State Legislature rejected various proposals that would have largely eliminated physician oversight of physician assistants (PAs). However, this year Governor Hochul and individual legislators are again proposing legislation that would adversely impact patient care by eliminating required physician supervision of care provided by a PA once the PA has reached a certain number of clinical hours.

As I wrote in a letter to the editor that was published in the Albany Times Union this week, physicians welcome discussion on ways to ensure our patients get the care they need. However, policy discussions on addressing physician shortages should focus on making New York’s challenging practice environment more welcoming for physicians, instead of trying to replace them. Nurse practitioners and physician assistants are essential for health care delivery, but they are not a substitute for trained physicians. I pointed out that a recent American Medical Association study finds that when non-physicians are permitted to practice independently, the difference in training results in increased health care costs and patient safety risks. Physician assistants and nurse practitioners play important roles in expanding access to care. But to ensure patient safety there must be appropriate physician oversight and collaboration safeguards in place.

And last week, Newsday’s  article “Nurse practitioners, physician assistants playing larger roles in health care — why some doctors are pushing back” reported the following:  amid the increasing prevalence of nurse practitioners and physician assistants in New York, “groups representing physicians say they need doctors’ oversight, especially in more complex cases, and they oppose efforts to increase their autonomy.”  Medical Society of the State of New York President Paul Pipia, MD, said, “The physician should be the leader of the team.” In 2022, New York eliminated a rule requiring NPs to “work under the oversight of a physician,” and “bills in the state Legislature” seek to do the same for PAs, “a move that groups representing physicians oppose.” The MSSNY is among those that “have lobbied against greater autonomy for physician assistants and nurse practitioners.” Dr. Pipia “said a physician has far more training and education: Four years of medical school and at least three years of a medical residency, compared with a master’s degree for nurse practitioners and physician assistants, which is typically obtained in two to three years.” Dr. Pipia explained, “I don’t think they have the requisite knowledge by training to work independently.”

I and many other physicians have raised concerns that scope of practice expansion as proposed by the Governor will lead to a two-tier system where only some New Yorkers will have the benefit of skilled physician oversight. Please remind your legislators that patients are best served by a team-based approach with a skilled physician overseeing and guiding patient care and urge them to oppose this legislation! Use MSSNY’s Grassroots Action Center to contact your legislator easily and quickly.

Paul A. Pipia, MD
President
Medical Society of the State of New York