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Training debate goes on in region

Nurse practitioners routinely treat local patients.

In fact, said one supervising doctor, some patients prefer them to physicians.

That’s because nurse practitioners typically see fewer patients and spend more time with each one, said Dr. Richard Cardillo, medical director of Lutheran Medical Group. Lutheran Medical Group is the largest member of Lutheran Health Physicians, an alliance of Lutheran Health Network-owned physician practices.

Indiana requires nurse practitioners to have a collaborative practice agreement with a doctor, who reviews a percentage of patient charts updated by nurse practitioners and serves as a resource on more challenging cases.

“We rely very heavily on our nurse practitioners. They’re a big part of our practice,” Cardillo said.

But how independently they work depends on the health care organization and the supervising doctor.

Fort Wayne’s VA Medical Center empowers nurse practitioners to work alongside physicians more as colleagues than supervisors, said Rebecca Gump, who has been a nurse practitioner for 21 years.

Gump treats her own roster of patients at the local facility run by the Department of Veterans Affairs. A percentage of her charts are reviewed, as the law dictates, but she doesn’t believe it’s necessary for the “well-trained” professionals to be supervised.

The philosophical differences seen nationally between doctors and nurse practitioners are evident locally, too.

Dr. Ronald Sarrazine, who practices internal medicine and pediatrics with Parkview Physicians Group, works in an office attached to Parkview Regional Medical Center. The practice includes nurse practitioners.

“Nurse practitioners are overseen and, really, their care is an extension of our care,” he said.

Parkview Physicians Group assigns nurse practitioners to patients with chronic conditions, including diabetes, for education and follow-ups on managing their diseases. The health care providers also treat patients who make a same-day appointment for illnesses that include flu.

Nurse practitioners in Indiana are allowed to write prescriptions – even for powerful narcotics – without a doctor co-signing the slip. If they didn’t have that authority, Sarrazine said, it “would certainly limit their ability to function.”

But, like their charts, their prescriptions are reviewed by doctors in the same practice.

Cardillo believes nurse practitioners are perfectly capable of giving a physical to a high school athlete, referring a patient to physical therapy or transitioning a terminally ill patient to hospice care.

But, he said, that doesn’t mean they should open their own clinics and work without doctor supervision.

“We try to pick and choose what they handle,” said Cardillo, who specializes in critical care medicine and pulmonary diseases. “They’re not doctors. The training isn’t there. The critical thinking isn’t there.”

Sarrazine, who is married to a nurse practitioner, agreed.

“I went through a lot of training in medical school and residency, and it took a lot for me to be where I am today,” he said. “They’re taking a big liability if they take that jump” to independent clinic ownership.

Sarrazine’s wife, who has never used her degree, is a full-time mother to their six children. Dr. Sarrazine knows the training she had to earn her credential.

“It was intense,” he said, “but it wasn’t medical school.”

Gump spent three years earning a master’s degree after completing four years of undergraduate nursing studies.

She rarely needs to ask for guidance in treating a patient, but she doesn’t hesitate to consult with a physician when necessary – not because it’s required by law but because it’s in the best interests of the patient.

The local nurse practitioner thinks doctors want a monopoly.

“We just want to be able to practice to the full extent of our capabilities,” she said, “just as they do.”

sslater@jg.net

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