Studies were undertaken to assess the practice prerogatives of nonphysician
clinicians (NPCs) in 10 disciplines that, collectively, are the major nonphysician
contributors to the delivery of medical and surgical services. These disciplines
include nurse practitioners, physician assistants, nurse-midwives, chiropractors,
acupuncturists, naturopaths, optometrists, podiatrists, nurse anesthetists,
and clinical nurse specialists. Marked differences were found in the practice
prerogatives that states granted NPCs in the various disciplines. For most
disciplines, the magnitude of their prerogatives correlated with the numbers
of NPCs practicing in each state. At their maximal levels, state practice
prerogatives authorized a high degree of autonomy and a broad range of authority
to provide discrete levels of uncomplicated primary and specialty care. The
recent growth in these prerogatives is fostering new opportunities for NPCs;
however, it also is creating a pluralism that has the potential to further
fragment the US health care system. It is time for regulatory integration
and professional collaboration so that a health care workforce that includes
a diversity of disciplines can be assured of providing a coherent set of patient
care services in the future.
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