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Florida Doctor Groups Push Back Against Giving Advanced Nurses Their Independence

Person wearing white doctor's coat stands with arms crossed holding a stethoscope.
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For years, Florida’s Advanced Registered Nurse Practitioners (ARNPs) have tried to convince lawmakers to let them set up offices independent of physicians. Doctor groups have largely opposed the move, but a lawmaker who happens to be an emergency medicine physician isn’t giving up.

Dr. Cary Pigman (R-Avon Park) has been working on this proposal since 2014--the entire time he’s been in the legislature.

“This is the 18th time I’ve presented this bill or related bills to this topic,” Pigman told the House Health Quality Subcommittee. He says he’s motivated by his experience as a doctor in a rural area.

“Florida, like much of the country, has a shortage of healthcare providers,” Pigman said. “As of the start of this year, we still had 279 primary healthcare professional shortage areas. Those are geographic areas in the state of Florida that are underserved.”

Pigman says the legislature is already trying to fix the problem by helping fund graduate medical education like residencies and creating debt forgiveness programs for medical professionals who move to underserved areas. He thinks House Bill 607 will also help by providing a pathway for ARNP’s to have their own independent practice.

In order for me to practice and take care of patients, I have to have a supervising physician. ~Mai Kung, FSU College of Nursing faculty

“It is sad for me to say in order for me to practice and take care of patients, I have to have a supervising physician,” said Mai Kung, speaking for the Florida Nurses Association. "This physician can be a newly licensed physician or a dentist.”

Kung has been a family nurse practitioner for more than three decades. She has a Doctor of Nursing Practice degree and teaches at Florida State University. Even with her experience and credentials, she can’t write a prescription or offer any real help to a clinical patient without a supervising doctor on site.

“Over 50 years of research data have demonstrated that ARNPs provide safe, high quality, cost-effective care,” Kung told the committee. “Patients treated by ARNPs have comparable health outcomes compared with patients treated by physicians.”

A legislative staff analysis found studies backing up those claims. The National Governors Association is one group that reviewed various studies which found treatment by an ARNP is just as safe as treatment by a physician.

Still, doctor groups aren’t convinced. “The patient expects and deserves that there will be a physician at least as part of their healthcare team,” said Jacksonville attorney Chris Nuland, speaking on behalf of the Florida chapter of the American College of Physicians. “As a result of this bill, were it to be enacted, you would allow for the exclusion of the physician from that healthcare team.”

“I remain convinced and humbled that the practice of medicine, both diagnostically and treatment-wise, requires an incredible skill set,” said Dr. Mark Dobbertien, speaking for the Florida Osteopathic Medical Association. “What is in the best interest of the patient is to ensure that a physician remains the leader of the healthcare team.”

Despite their concerns, Rep. Richard Stark (D-Weston) was the only lawmaker on the panel who voted against the bill, saying he’s worried about potentially lowering the overall quality of healthcare.

I just can't vote for a bill that's going to take away the doctors being in control. ~Rep. Richard Stark

“I’m going to have to be, as I said to a few of my colleagues, the dinosaur on this,” Stark said. “I just can’t vote for a bill that’s going to take away the doctors being in control.”

Before the vote, Rep. Rene Plasencia (R-Titusville) said Florida is behind most states on this issue. “Representative Stark made a great point,” Plasencia said, “not so much that he’s a dinosaur, but that we in the state of Florida are the essential dinosaurs because thirty states in our country currently have independent practice or some form of it.”

The bill easily passed the committee. It’s considered a priority bill of House Speaker Jose Oliva. No similar proposals have been filed in the Senate, and that chamber has historically opposed these changes.

Gina Jordan is the host of Morning Edition for WFSU News. Gina is a Tallahassee native and graduate of Florida State University. She spent 15 years working in news/talk and country radio in Orlando before becoming a reporter and All Things Considered host for WFSU in 2008. Follow Gina: @hearyourthought on Twitter. Click below for Gina's full bio.