In the United States, 28 states are considering expanding the authority of nurse practitioners. If they hold a doctorate, they want to be called ‘doctor’.

The nurse practitioners there say that they are highly trained and skilled and know when to refer patients to specialists. They spend more time with patients and charge less, but the American Medical Association says that expanding the authority of nurse practitioners may put patients in danger. (APS, Dallas).

In Australia in March, the senate passed legislation that will allow nurse and midwife practitioners to provide treatment under Medicare and prescribe medicines under the Pharmaceutical Benefits Scheme. In its statement to the media about the changes the government said,

“Nurse practitioners are also at last to be supported to work to their full potential and provide care in the most appropriate settings, such as aged care facilities, primary care settings or people’s homes. At a cost of nearly $60 million, this will expand services to many families who currently struggle to access health care.” (http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr10-nr-nr050.htm)

With shortages of GPs particularly in rural areas, the option of a nurse practitioner is the best option that many patients may realistically have. Regarding the reforms mentioned above, the Australian Medical Association said, “… there is a lack of evidence to support the substitution of doctors with other health professionals and that there are inherent risks in doing so.” (http://www.ama.com.au/node/4841)

In a paper I wrote for the Journal of Law and Medicine, I suggested that if the AMA wanted to criticise the standard of care that nurses provide, then it should contribute to ensuring that access to their services – medical services – could be obtained by those living in rural and remote areas. The standard of care provided by nurses in these remote communities is high; they refer complex matters to the Royal Flying Doctor when necessary and so far there seems to have been few complaints about this made by the AMA. Why then would we expect that this model applied anywhere else (read cities) would be a problem?