Doctors more worried than ever about nurse practitioners getting expanded role

The Assembly has twice rejected bills to expand nurse practitioners’ duties, but an Assembly committee gave such a bill unanimous support last month.

California doctors’ long-held opposition to nurse practitioners expanding their scope of practice into areas now reserved exclusively for doctors has become even more intense with the growing evidence that medical technology enhanced by artificial intelligence can play a much bigger role in health care. Nurse practitioners with such powerful tools could conceivably supplant doctors in many areas of medicine.

But state lawmakers — concerned about California’s increasingly severe physician shortage — seem ready for big changes. Last month, the Assembly Business and Professions Committee voted 16-0 for Assembly Bill 890, by Assemblyman Jim Wood, D-Healdsburg. It would allow properly certified nurse practitioners to order and interpret diagnostic procedures and to prescribe some drugs, among other duties, without supervision by a medical doctor.

In 2013 and 2015, bills expanding nurse practitioners’ scope of duties passed the Senate before dying in the Assembly. That makes the unanimous Assembly committee vote look even more significant.

The committee first heard testimony about the findings of the California Future Health Workforce Commission, which warns the state faces a shortage of 4,100 doctors in coming years. In February, the commission — chaired by University of California President Janet Napolitano — urged California to join the 22 states which already allow nurse practitioners to work without a doctor’s supervision in some areas of health care.

CMA: Change would lead to lower quality of care

That prompted criticism from the California Medical Association: “We continue to oppose efforts to lower standards of care to expand access. Nurse practitioners, while hugely important to the health care delivery system and an integral part of medicine, do not have the same level of training and expertise, and we should be wary of creating a system that only allows those patients who can pay top dollar access to a fully trained and licensed physician.”

But a March report by the Brookings Institution pointed to a future in which such physicians are much less important. It noted research that showed an artificial intelligence system “was equal or better than radiologists” at evaluating mammograms; that computers are as competent as ophthalmologists in examining some retinal images; and that robots which performed intestinal surgery on a pig did much better than humans with the sutures used to close up surgical incisions.

Bay Area physician Rahul Parikh, writing in October in the MIT Technology Review, thinks specialists may be in trouble — but not family doctors, who can use artificial intelligence to improve their care. And he argues that any transition to a health care system reliant on AI will face profound questions.

“Are patients willing to share more of their personal data with us? If the AI shows your care is better one way, but you or your doctor feel differently, will an insurance company accept it?” he wrote. “What if the algorithm misses something or is applied incorrectly? Who is liable, the doctor or the machine’s maker?”

Assembly Bill 890 will be heard next by the Assembly Appropriations Committee. No hearing date has been scheduled yet.

6 comments

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  1. Orca
    Orca 13 May, 2019, 14:15

    I’m convinced 90% of what walks into a standard GP’s office could be handled by a qualified, experienced RN

    Reply this comment
  2. Ulysses Uhaul
    Ulysses Uhaul 14 May, 2019, 09:59

    What a crock……. “practitioners” are a step up from bowling alley pin setters as far as medical training, time in grade, education.

    California truly lost it’s way-

    Do you have hives, measles or you drank too much Walgreen wine???

    Reply this comment
    • Joe
      Joe 14 May, 2019, 15:53

      Where have all the good pack-n-ship men gone?

      Our state turns its lonely eyes to you…

      Reply this comment
      • Ulysses Uhaul
        Ulysses Uhaul 14 May, 2019, 19:01

        We lost some pretty good posters, namely, Eck, Poodle, that truly insane Donkey, a couple carpetbaggers from Oregon and Nebraska and that besieged retired California government worker gal. The CWD Sage Teddy Steele has been strangely silent too.

        Only Uli and challenging Comrade Queeg….

        By the way Vicious and Baby are doing fine, and we give em the FreshPet treats not that Chewy mail order stuff.

        Reply this comment
  3. Queeg
    Queeg 15 May, 2019, 11:10

    Comrades

    I’m waiting for brochures from Mats-att-lan to become a certified medical practitioner intern 3rd degree trainee through a grueling six week online process.

    They even send sterilized rubber arms, legs, buttocks with target marks to practice giving black plague shots.

    I’m stoked! Found my way out of the declining doomer trailer rental biz…..

    Reply this comment
  4. truthheals
    truthheals 28 May, 2019, 22:09

    Consider this: Artificial intelligence is only as good as the data input. What does it take to spot the most critical sign? The eyes only see what the mind knows.

    Reply this comment

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Chris Reed

Chris Reed

Chris Reed is a regular contributor to Cal Watchdog. Reed is an editorial writer for U-T San Diego. Before joining the U-T in July 2005, he was the opinion-page columns editor and wrote the featured weekly Unspin column for The Orange County Register. Reed was on the national board of the Association of Opinion Page Editors from 2003-2005. From 2000 to 2005, Reed made more than 100 appearances as a featured news analyst on Los Angeles-area National Public Radio affiliate KPCC-FM. From 1990 to 1998, Reed was an editor, metro columnist and film critic at the Inland Valley Daily Bulletin in Ontario. Reed has a political science degree from the University of Hawaii (Hilo campus), where he edited the student newspaper, the Vulcan News, his senior year. He is on Twitter: @chrisreed99.

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