Dr. Madara warned the independent-practice approach “would further compartmentalize and fragment health care delivery.” In contrast, maintaining the standard of physician-led team-based care “would foster integration and coordination,” he wrote. The letter also speaks to a common argument in favor of expanded scope of practice for nonphysicians—that it would make care more accessible. “As data suggest, CNM independent practice does not lead to increased access to care or greater distribution of health care professionals.”
Dr. Madara addressed keys factors that demonstrate why “physicians are uniquely qualified to lead the health care team.”
There is a stark difference in the time and depth of the training between physicians and CNMs. The path to becoming a physician entails more than 10,000 hours of clinical education and training. Residencies can last from a minimum of three years to as many as seven, on top of four years of medical school. “In comparison, CMNs have only between 500–720 hours of advance nursing education and training,” Dr. Madara pointed out, detailing the disparities in qualifications.
“Physicians’ education, clinical training and continuing medical education ensures that they are well equipped to diagnose and manage patient care,” he wrote, adding, “Patients want physicians to lead the health care team.”
The AMA has surveyed patient preferences in terms of how their care should delivered. Ninety-eight percent of patients said physicians and nurses need to work together to get patients the care they need.
In terms of the physician’s role, 91 percent of respondents considered a physician’s education and training “vital,” all the more so if there is a complication or medical emergency. Eighty-six percent acknowledged the benefit of a physician’s team leadership for patients with chronic conditions or comorbidities. “Four of five patients prefer a physician to have primary responsibility for leading and coordinating their health care,” according to the letter.