The end of (quote-unquote) supervision?

supervision pic

You may already be familiar with how truly, madly, deeply annoying I find the term “supervision”.

I mean, not in its appropriate context, obviously. My daughter, despite being quite precocious for a kindergartener, still requires supervision while using grown-up scissors. My son, who seems to think he’s capable of essentially any physical feat imaginable, needs pretty much constant supervision, since he’s nearly always wrong. Not at all developmentally inappropriate for a toddler, but still. If we want him to survive childhood, supervision is definitely required.

Clearly, supervision has its place. But some problems arise when we start using the word to describe a mandated relationship between a physician and a nurse practitioner. Not the least of which is the fact that I tend to take issue with the intentional misuse of language. It’s kind of a pet peeve.

I wrote something about why exactly I find the word “supervision” so annoying a few months back. (Go ahead, I won’t judge you for clicking.) Afterwards, an NP from another state read it and said something along the lines of “Huh. Supervision? Is that still a thing in some places?”

Yeesh. Why yes. Yes, it is still a thing. In some places. Apparently.

Thing is, I never dreamed that moving to an uber-progressive state would mean I would still be subject to outdated laws that don’t make any logical sense. Maybe that whole no-buying-alcohol-on-Sunday-mornings thing should have tipped me off?

Don’t get me wrong. It’s not like you’d have any idea there were any restrictions on my practice on a daily basis. I go to work and see my patients, order my labs, write my prescriptions, write my notes. Pretty mundane, actually.

Except for this one annoying thing where all my prescriptions have a second name on them: the name of my “supervising physician”.

And even though my “supervising physician” is pretty great, this bugs her as much as it bugs me. And I totally get it. I’d probably be super annoyed too if there were a bunch of prescriptions out there with my name on them that I had nothing to do with writing. Risk exposure much?

Ah well. I’d just assumed it was something I needed to get used to. Just like I got used to the sight of seeing tarps thrown over the beer section at the supermarket whenever I happen to find myself grocery shopping on a Sunday morning. (Actually… nope, still haven’t gotten used to that either.)

But then I finally opened one of the emails that the Massachusetts Coalition of NPs has been sending me to find out WAIT, WHAT? There’s an actual, real-life bill at the State House RIGHT NOW that could fix this?

True story! It’s called HB2009/SB1079, or “An Act Improving the Quality of Health Care and Reducing Costs”. And it’s pretty great. (Even if it could really use a new name.)

I’ve heard that some of the arguments that legislators are hearing against the unfortunately-named bill sound like this:

  • “NPs and CRNAs are not educated enough.”
  • “Patients will be harmed because they don’t know what they don’t know.”
  • “They need continued oversight in order to be safe for patients.”

Here’s the thing, people-who-either-said-these-things-or-wish-they-did. I hate to break it to you, but that ship has left the dock. The train has left the station. The car has left the carport. NPs are already seeing patients and making diagnostic decisions and prescribing stuff – lots of stuff! – on their own, every single day. Whether you like it or not. It’s already happening! You’re too late!

And that’s why I have such a hard time understanding why physicians would be AGAINST removing the supervision language from the books. If my name is going to be attached to someone’s actions, I want to be sure I had something to do with it. But “supervising” MDs? They get all the risk that comes with clinical decision making and prescribing, with none of the power to actually make those decisions. How does this sound like a good deal?

Well, maybe if your income was affected by how many NPs you “supervise”, it would sound like a great deal. As long as that whole risk-under-your-name thing doesn’t bother you too much.

…But wait a sec. If you’re confident enough in the abilities of the NPs you “supervise” to feel comfortable with this level of risk, one might surmise that maybe you don’t actually, deep down, think NPs are all that unsafe after all… which would suggest that all these protests about “safety” may be just a teensy bit disingenuous, no?

In conclusion: this bill rocks, and its time has come. So if you live in Massachusetts and agree with my pointed use of quotation marks around the word “supervision”, please – figure out who your rep is and call, or email, or carrier-pigeon over your thoughts on the matter.

Thank you. That is all.

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One thought on “The end of (quote-unquote) supervision?

  1. Agree totally. Your PA cousins are jumping to collaborative practice and some are also asking the same questions. Yes, teams work. No I don’t need to be “supervised” after a great clinical education and 50 years as a profession.
    And I know what I know, and more importantly what I don’t know. Hopefully most physicians do also!
    Dave Mittman, PA, DFAAPA

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