Regulated Relationship?


As the American Medical Association (AMA) develops a toolkit to help physicians implement contracts that govern the professional relationship between physicians and non-physician providers (NPPs), one SHM committee member says the trade group should keep an open mind on the pros and cons of such agreements.

The AMA House of Delegates last month tasked its staff to develop the toolkit after several delegates expressed concerns that without the so-called “practice agreements,” NPPs and physicians do not have clear boundaries on the scope of practice responsibilities, according to American Medical News, the society’s newspaper.

Lorraine Britting, MS, NP-C, a member of SHM’s Non-Physician Provider Committee, says the agreements can be a framework for certain practices but might be seen as burdensome to HM groups that have worked for years without the contracts in place.

“In the states that already have practice agreements mandated, you put these regulations in place and they work well. That being said, if new requirements are too restrictive, there is certainly potential for there to be some conflict between the physicians and the nurse practitioners,” says Britting, lead nurse practitioner in the department of cardiology medicine at the Cardiovascular Institute at Beth Israel Deaconess Medical Center in Boston.

Britting notes that many HM groups already have practice agreements in place and that she has never worked without one because Massachusetts requires them. She says professional relationships between doctors and NPPs could be helped by rules on who is responsible for what—but only if those agreements are developed with input from all stakeholders.

“It’s hard to make a blanket statement. Someone who has 10 years’ experience working in hospital medicine versus somebody who just graduated ... their needs are going to be very different,” Britting says. “It has to be individually tailored.”

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