VHA Hospitals want to substitute Nurses for Doctors

The Veterans Health Administration is taking heavy fire from doctor groups over a proposal to let nurses with advanced training practice medicine without physician supervision throughout the VHA system—even in states where laws require more oversight. 

More than 60 state and national physicians groups have signed a letter to the Department of Veterans Affairs expressing "strong concerns" that the proposed new nursing handbook would "effectively eliminate physician-led team-based care within the VHA system."

Some 40 nursing organizations have countered with letters applauding the proposed changes, which they said "will further facilitate timely delivery of high-quality health care to our nation's service men and women." 

The VHA dispute mirrors skirmishes across the nation over the roles nonphysician health providers should play in medical care, with doctors in short supply in some areas and more Americans gaining health insurance. Physician assistants, nurse practitioners and other so-called physician-extenders are increasingly taking on duties once performed solely by doctors, but state scope-of-practice rules differ widely on how much autonomy they have.

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The efforts at the VHA—the nation's largest health-care system, with more than 1,700 hospitals, clinics and veterans centers in all 50 states—are being closely watched. The department's overall budget, which is $140 billion this year, has risen 40% since 2009, but the system is struggling to treat a surge of veterans with mental-health issues and to end a backlog of disability claims.

Last month, the VHA issued new guidelines for its 2,200 physician assistants, lifting some restrictions and letting individual PAs and their "collaborating physicians"—previously called "supervising physicians"—determine how much autonomy the PA should have. The American Academy of Physician Assistants hailed the new directive as a "model of flexibility."

The proposed nursing handbook is generating more opposition. As currently drafted, it would recognize the VHA's 6,135 advance-practice registered nurses—including nurse practitioners, nurse anesthetists, nurse midwives and clinical-nurse specialists—as independent practitioners authorized to care for patients without direction or supervision by a doctor. For nurse anesthetists, for instance, that includes administering anesthesia in surgeries, managing acute-pain services and being the lone anesthesia provider in some clinics.

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IMHO, this is only the beginning. I'm predicting this will be standard procedure in most hospitals.

Seeing a REAL Doctor will become a rarity. WELCOME TO OBAMACARE....

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