Nurses have been moving steadily, relentlessly toward more autonomy and responsibility, advancing ever more boldly in the past few years into territory previously controlled by physicians. Now the doctors, feeling threatened, are counterattacking.
The issue is whether registered nurses with advanced training should be allowed to deliver primary health care on their own. Primary care refers to the first contact a patient has with the health-care system. It's the basic, initial care that you receive when visiting a clinic or a doctor's office - the care you get before being referred, if necessary, to a specialist.Registered nurses have been delivering this kind of care for decades, but almost always under the supervision of doctors.
In recent years, however, nurses with advanced training - such as nurse practitioners and nurse midwives - have been moving toward greater independence.
In many states, including New York, nurse practitioners are allowed to write prescriptions and to be reimbursed by third-party insurers.
As long as the nurses were working for the doctors, there wasn't much of a problem. The nurses lightened the workload. They helped bolster profits.
Now the Clinton administration, with its health-reform package emphasizing primary care, has added its considerable weight to the move toward greater responsibility for advanced-practice nurses.
Last week the doctors struck back. The American Medical Association issued a report that could easily have been titled, "Enough Is Enough." It criticized virtually every argument on behalf of greater autonomy for nurses. "Quality medical care," the report said, "requires that a physician be responsible for the overall care of each and every patient."
The AMA even rejected the idea that nursing care is less expensive than physician care.
That is particularly interesting when you consider that the average income for doctors last year was $170,600, while for nurse practitioners it was $43,600.
But the cornerstone of the doctors' argument is that nurses acting independently would be a threat to the health of their patients.
There does not seem to be any evidence at all for that argument.
Mary Mundinger, dean of Columbia University's School of Nursing, noted that nurse practitioners have been delivering primary care since 1965 and that hundreds of studies have examined the quality of their work, including their diagnostic ability and management effectiveness.
If nurses with special training are delivering high-quality health care at a reasonable cost, then we need a reason other than doctors' anxiety to stop them.