Health care delivery in California is moving toward an integrated model that brings together physicians, nurses and other health professionals, each playing a specialized role as a member of a team. As professionals that have served in multiple roles on that team, and done the training for each, we believe we are in a unique position to comment on Senate Bills 323 and 622, which would alter the roles of nurse practitioners and optometrists, respectively.
As a dermatologist who was first a physician assistant and an ophthalmologist who was first a registered nurse, we can say from our collective personal experience that nurse practitioners and optometrists play a critical role in delivering patient care. Yet, both pieces of legislation greatly increase the responsibilities of these individuals without meaningful corresponding increases in their training.
In fact, medical students have about three times as much supervised training when they graduate, but we don’t grant them independence.
To become physicians – and in our cases this was after doing the several years of training for our initial roles – each of us had to undergo four years of medical school, a one-year internship, and an additional three years of residency. We had each undergone over 10,000 hours of supervised clinical work by the time we were allowed to practice independently, and we both believe that privilege shouldn’t be taken lightly. That extensive level of training prior to independent practice is not just for “show.” It is to ensure patient safety.
So both as allied professionals and also physicians, we’re concerned about SB 323, which would grant nurse practitioners the ability to function independently with only around 500 supervised direct patient care clinical hours – about one-twentieth of what MDs have.
In fact, medical students have about three times as much supervised training when they graduate, but we don’t grant them independence. In fact, they can’t even be licensed without another full year of training. They just aren’t ready.
Yet, under SB 323, a nurse practitioner who passes a national certification exam would be able to prescribe medication to and perform even surgical procedures on a patient unsupervised. In essence, the bill sets up different standards of training for the same care.
Since we are both now surgeons that deal with the types of tumors SB 622 would allow optometrists to “determine clinically are non-cancerous” and remove, we can say that such a determination will be wrong enough of the time to make that an extremely dangerous standard. Even more dangerous, however, would be allowing someone to do scalpel surgery with the trivial amount of training that would be required: a 25-hour course and a tiny fraction of the number of surgical cases either of us had to do in our residencies.
The training to do laser eye surgery is no better: a 25-hour course and a similarly small number of cases that are not enough to bestow competence. It is also worth noting that our Veterans Affairs facilities have a national policy – called a “directive” – that prevents optometrists from doing the very laser surgeries that this bill would authorize them to do on Californians.
Having experienced the training of two professions, we realize how much we didn’t know as allied health professionals that we now do as physicians. California’s citizens deserve, and quite frankly need, far better than what would result if SB 323 and SB 622 were to become law.
We urge the Legislature to reject both proposals.
Ed’s Note: Dr. Linda Davis-Reed, a former physician’s assistant, practices dermatology in Chico. Dr. Denise Satterfield, a former registered nurse, practices pediatric ophthalmology in Sacramento.