SCOPE OF PRACTICE
The Changing Role of Physician Collaborators
by JOHN J . WERNERT , MD
The decision to become a physician comes with an automatic predilection towards assuming various roles as students , teachers , mentors and collaborators . Aloof and suspicious individuals typically chose other professions that fit their personalities and don ’ t involve the “ messiness ” of being in the “ caring for people ” business of medicine . Most of us gladly accept these tasks , whether learning from professors , working under more experienced clinicians , accepting advice from colleagues or teaching skills to others : collaborating is what makes our experience rich , and propagates our profession . When we improve ourselves and the skills of others , the patients and families we serve benefit immeasurably . One of these roles has always been to guide and oversee the care delivered by other licensed professionals , especially those with expanded scopes of practice .
For decades , physicians have served as “ collaborators ” for other skilled professionals who were viewed as “ extenders ” of the doctor and performed regular duties “ incident to ” what was previously performed ( and billed ) by a licensed clinician . As manpower shortages worsened and demand escalated , many saw that such extenders offered access and could bill for services near a physician ’ s rate without the same salary and costs . Federal and state agencies loosened restrictions , especially state Medicaid programs , to allow network access that would accept lower payment for the covered recipients . So many physicians got on board overseeing care in their individual practices , working side by side with other providers , reviewing records and prescriptions , to regularly ensure patients received the care they need . Nursing schools also began offering advanced practice degreed programs to take advantage of this expanded opportunity . We now have a plethora of advanced nursing degrees with thousands of newly minted NPs ( nurse practitioners ), APRNs ( advanced practice nurse practitioner ) and various APPs ( advanced practice providers ).
Historically , this oversight relationship changed 25 years ago when many physicians moved away from private practice models and became employed by hospital systems . Soon after , organized nursing organizations began intensive lobbying of legislatures and
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