To the Editor: Dr Cooper and colleagues1
explore some of the trends of nonphysician clinicians (NPCs) and their
march to increase their scope of practice, but stop short of analyzing
what impact this "high degree of autonomy" will have on patient
care. While much can be learned through hindsight, the public cannot
afford to have the medical community take a wait-and-see attitude in
this matter.
As president of the American Society of Anesthesiologists, our
organization and I have substantial experience with efforts by
certified registered nurse anesthetists (CRNAs) to expand their scope
of practice. The stated intention of CRNAs, to be able to practice
independently of any medical supervision, should make it clear to
physicians in primary care and specialty practices alike that many
"nonphysician clinicians do not aspire merely to complement
physicians," as Drs Grumbach and Coffman noted in their
Editorial.2 If NPCs want to improve patient care, as they
claim, why are some of them so intent on severing all ties with
physicians who bring medical expertise and judgment to the table?