110.998 Non-physician Practitioners in Today’s Health Care Delivery Systems:
(A) Scope of Practice: While the Medical Society is certainly concerned about system costs, our primary focus is and must be on quality. We believe, therefore, that non-physician professionals should be used in a manner commensurate with their training. It is clear, furthermore, that how we pay non-physician practitioners will directly affect how they practice. The medical community firmly believes that non-physician practitioners lack the education and training necessary to practice independently of physicians. A serious danger to the well-being of the citizens of this state will result if health care professionals, competent within their own fields, are permitted to work in areas beyond their competence and training and/or without an appropriate relationship with a physician. Moreover, to the extent that some advocate the expansion of the services performed by non-physician practitioners in the pursuit of system economies, but without an adequate educational base, costs will inevitably increase, not decrease. Therefore, while the Medical Society is committed to ensuring the efficient and responsible integration of these professionals into health care delivery teams, we should be moving toward an integrated system, not reversing statutorily created interrelationships which foster cohesion in our health delivery processes rather than fragmentation. Consequently, MSSNY strongly opposes any expansion of the scope of practice of non-physician practitioners which would undermine the quality of health care and compromise public safety.
(B) Practice Setting and Distribution: Certain interests recommend increasing the number of non-physician practitioners to address perceived provider shortages in underserved areas of the state. MSSNY, for a variety of reasons, questions the reasonableness of this conclusion. Generally, it is difficult to entice physicians to practice in such locations where they must be on call constantly, have few professional colleagues with whom to interact and where their spouses may not be able to find suitable jobs in such settings. Non-physician practitioners face similar, If not the same disadvantages. Furthermore, government should always be alert to initiatives which could result in the establishment of a two-tiered system of health care and, in effect, deny physician services to the elderly, poor and chronically ill. In light of the efforts of managed care organizations to significantly constrict staffing levels, and in view of the persuasiveness of managed care in New York State, we submit that government should carefully examine future work force requirements generally.
(C) Manner and Extent of Compensation: In certain government forums, non-physician practitioners are advocating that they should receive the same amount of compensation paid to physicians for certain services. MSSNY specifically opposes any policy which would implement “parity” of payment between physician and non-physician providers. MSSNY supports the implementation of a differential payment structure based upon the provider’s level of training, skill, expertise, responsibility and practice costs. Such a payment structure must necessarily recognize the inherent distinctions which exist between the extent of physician education and training as compared to that of non-physicians. Such distinctions in education, training, legal recognition and scope of practice demonstrate beyond argument the lack of any “equivalency” of service despite the claims by some non-physician practitioners. As noted above, the education of a nurse practitioner can be completed in as few as thirty-one months consisting of two years of junior college and nine months of advanced nurse practitioner certification program, or in as much as six years including four years of college and two years in a combined masters and certificate training program. By contrast, generalist physicians have at least eleven years of education and training, including four years of college, four years of medical school, three years of residency and often, additional years of fellowship training. A differential payment structure which recognizes and compensates those with greater skill, knowledge and training is absolutely necessary to assure that dedicated, talented and intelligent individuals are attracted to the profession of medicine. Obviously, young women and men are motivated to pursue the long and arduous work of medical licensure for a variety of reasons, not the least of which is the unique opportunities which the profession offers to serve society in a very direct and personal way. However, we must also recognize the necessity of fair and adequate compensation for those who pursue this course. Without such a structure, there would be inadequate training required of physicians today.
MSSNY strongly supports the provision of payment to a physician for all services provided by non-physician practitioners under the physician’s supervision and direction regardless of whether such services are performed when the physician is physically present, so long as the ultimate responsibility for such services rests with the physician. Such a payment relationship is completely consistent with the functional relationships required by NY law which clearly prescribe that the physician is ultimately responsible for services provided by nurse practitioners and certified nurse midwives with whom the physician is collaborating, and physician assistants who the physician is supervising. As a result, MSSNY opposes direct reimbursement to non-physician practitioners. (Council 1/19/95; Reaffirmed HOD 2014; Reaffirmed HOD 2024)
