In addition, the Department of Veterans Affairs last year began allowing NPs to practice solo, without any connection to doctors. And last July, VA facility managers received an agency memo encouraging the use of NPs when vacancies arise for primary care physicians. NPs at the clinic are not only providing primary care, but they're being listed in the all-important directories published by the HMOs, references that help steer patients to participating providers. Advocates for NPs point out that physicians shouldn't feel threatened by the move toward more independence for NPs. We're just a valuable option in the mix.
Physicians wary Many physicians in the state, however, are wary.
For years, NPs in New York have fought for the right to practice more independently of physicians, an effort that led to legislation that describes NPs' relationship with physicians as collaborative, not supervisory. The law also gives NPs unrestricted prescriptive authority, full diagnostic and treatment capabilities and hospital admitting privileges. They have a collaborative practice agreement that addresses clinical protocols, that talks about the appropriate timing of referrals and when the primary care physician should jump in. In short, critics complain, the ads give the impression that NPs at the clinic replace the primary care physician. Some NPs at the clinic reinforce that image.