Physician Anesthesiologist Prevents Parent’s Worst Nightmare

Just like the North Carolina General Assembly, many other state legislatures across the country are considering legislation that would remove the requirement of physician supervision of nurses.  In Michigan, SB 320 would propose to allow Certified Nurse Anesthetists (CRNAs) to practice without physician oversight. This proposal was concerning enough to one Michigan mother – a mother who also happens to be a nurse – that she was prompted to write an opinion piece to her local paper.

Read the account of her daughter’s near death experience while in the dental chair and how the leadership and expertise of a physician anesthesiologist prevented the worst case scenario, HERE.

It is our hope that North Carolina lawmakers will heed the warning of this story and protect North Carolina patients by maintaining physician supervision of all advanced practice nurses – including CRNAs.

The Mistake of a Lifetime

One of these moles is harmless, one of them is a life-threatening melanoma.

Dermatologists train for more than a decade to know the difference.

Melanoma is curable if it is caught early—so a correct diagnosis is literally the difference between life and death.

SB695 and HB807 would allow nurses to diagnose skin cancer without back up from a supervising dermatologist.

For a patient with melanoma, that could be the mistake of a lifetime.


*In the above example, the larger mole is benign. The smaller one is cancerous.

View a pdf of this handout, courtesy of the NC Dermatology Association here.

Eliminating Supervision of Nurses Won’t Improve Access to Care in Rural NC

The NC Coalition to Protect Patients supports team-based healthcare. To protect patients, the healthcare team must be led by those with the highest level of training – physicians.

SB 695/HB 807 would end physician supervision of many types of nurses and fragment the healthcare team. Supporters of these bills say that, once unsupervised, nurses will relocate from the urban areas to rural communities and expand access to health care. This is a false and dangerous promise.

The American Academy of Nurse Practitioners reports that only 18% of Nurse Practitioners practice in rural areas.

North Carolina’s supervision requirement protects patient safety – it does not prevent nurses from practicing in rural or underserved areas.


Current law requires that supervising physicians and nurse practitioners work as a team and be continuously available to one another for consultation via direct communication or telecommunication and that a written plan is developed for performing various medical tasks, prescribing medications and handling emergency situations.

Although supervised, in North Carolina there are no limits on nurse practitioners in regard to geography or practice location. In states that have authorized the independent practice of nurses, neither access to care nor the cost of care has substantially improved.

There is no evidence that eliminating the safeguard of physician supervision will improve access to medical care in rural North Carolina.

Physicians are the number one provider of primary care services in North Carolina’s rural counties. Even in NC counties containing federally designated Health Professional Shortage Areas, Primary Care Physicians outnumber nurse practitioners by more than 2,600.

In fact, eliminating physician supervision of nurses is more likely to harm patients in all areas of our state. Current administrative rules require supervising physicians and nurse practitioners to continually work together to evaluate the quality of the care provided to their shared patients and to create plans to improve clinical outcomes.

SB 695/HB 807 eliminates the Quality Improvement Process currently in place between doctors and nurse practitioners.

This puts patients at risk for unnecessary, adverse outcomes – no matter where they live.

For these reasons, the Coalition opposes SB 695 and HB 807.

Who’s Who In Your Healthcare Team?

Healthcare is a team sport. Every player has the important role of providing access and managing costs. When it comes to safety, leadership of the healthcare team must remain with those with the highest level of education and training. Physician supervision is key to protecting North Carolina patients. For this reason, the Coalition opposes SB 695/HB 807.

Naturopath Licensing Bills Put Patients at Risk

As crossover approaches at the North Carolina General Assembly it is possible that SB 118/HB 913 – Naturopathic Doctors Licensing Act may be debated. This legislation proposes to create a third classification of physician in North Carolina.

Current law permits the licensure of Medical Doctors (MD) and Doctors of Osteopathy (DO) – both regulated by the North Carolina Medical Board. SB 118/HB 913 propose to license Naturopathic Doctors (ND) under their own licensing board.
Only 18 states currently license naturopaths, none of which are in the Southeast.

Allowing practitioners without medical training to refer to themselves as doctors is confusing to the public and poses a risk to safety. Use of the initials ND is especially confusing when compared to MD (medical doctor) and NP (nurse practitioner) titles.

SB 118/HB 913 would allow naturopaths to order tests and manage chronic disease as a primary care provider. The bills allow naturopaths to treat infants and children, diagnosis and treat mental health conditions, even diagnosis and treat cancer.

If naturopathic treatment is endorsed by the legislature as adequate treatment of life-threatening and chronic disease, patients are put in harms way. Ineffective naturopathic treatment could delay much needed medical services, leading to complications and even death.

Finally, in states where naturopaths have been licensed, there appears to be an immediate and constant push for expanded scopes of practice to include the ability to prescribe controlled substances. The American Association of Naturopathic Physicians notes on its website, “… seven more states are pursuing scope modernization, particularly expanded prescribing authority” this year alone.

For these reasons the Coalition opposes SB 118 and HB 913.

SB 695/HB 807 Puts Mothers and Newborns at Risk

North Carolina’s OB/Gyn doctors and Certified Nurse Midwives work side-by-side as partners to ensure that their patients – women and soon-to-be-born children – get the best and safest care possible. Cooperation and high standards of care are only enhanced by flexible, but necessary, physician supervision of nurse midwives. Physician OB/Gyns complete twice as many years of education and over ten times as many clinical training hours as nurse midwives.

Nurse midwives are an essential part of a team approach to ensuring the safety of thousands of mothers and children in our state. As with any team, leadership by those with the most experience and education is necessary.

Every mother and child deserves the best and safest care. Lowering standards of care – reducing safety – to increase access to care is a false choice that no woman or family should face. That’s why NCCPP opposes reducing safety standards such as eliminating the requirement that nurse midwives work supervised by a physician.

Passage of SB 695 or HB 807 would allow lesser qualified providers to direct the care of patients with the highest risk. It could also leave those providers unprepared to handle complications that arise in even the healthiest patients. Passage of this legislation will give women and their families a false sense of security that midwives can do everything necessary to keep mothers and their newborns as safe as possible.

Every pregnant woman and every newborn in our state deserves the best and safest care – because problems during labor and delivery can come at any moment, without warning, for even the healthiest women.  Eliminating physician supervision of nurse midwives is simply not worth the risk.

Keep Physician Supervision, Oppose SB 695

Did you know that physician supervision provides greater flexibility to the way nurses practice in our state?

North Carolina law is unique from many other states in that it is accommodating to both nurses and physicians – resulting in better patient care. While other states limit nurses to the skills acquired during 1-2 years of training, North Carolina law allows nurses to expand their expertise well beyond their formal education. This broadening of their responsibilities is achieved by working side by side with a supervising physician.

Physician supervision allows nurses to achieve additional on the job training from someone with over a decade of medical education, thereby practicing well beyond what was learned in nursing school.

In fact, advanced practice nurses in North Carolina can perform any medical act approved by a supervising physician.

Supervision allows nurses to practice to the fullest extent possible, while 
maintaining the safety net of physician expertise vital to patient safety.

As the needs of our state change, physician supervision allows nurses to maximize their skills and practice without the limitations of their training. Otherwise, nurses simply do not have the training necessary to safely and independently practice medicine.

Senate Bill 695 proposes to allow nurses to independently provide neonatal care, mental health services and any other medical care across the life span of a patient – despite very limited training.

Two years of education prepares nurses to follow pre-approved protocols, but it does not prepare them to independently diagnose and treat complex disease.

Nurses play a vital role in the patient care team, but
two years of training is no substitute for the expertise of a physician.

For these reasons the Coalition supports physician supervision of nurses and opposes SB 695.

Physician Supervision of Nurses: It’s All About Safety

Doctors can train for as long as 15 years before they are allowed to treat patients without supervision – because extra years of training can mean the difference between life and death. A nurse’s’ training is considerably shorter – which makes their supervision by a physician critical to patient safety.

For this reason the Coalition supports continued physician supervision of nurses and opposes SB 695.

Medical Training

Medical school is a rigorous, full-time, four-year program consisting of classroom work as well as thousands of hours of clinical training. After graduation, MDs enter into a residency program that ranges from 3-7 years of additional training. In some instances, fellowship training may also follow, adding 1-2 more years to the process.

Physicians train for at least a decade – some for much longer – before
they are permitted to practice without supervision.

The years required to become a physician are essential, ensuring that physicians of all specialties – from primary care to neurosurgery – obtain the knowledge and skills necessary to safely practice.

Nursing School

Nurses obtain their certifications in a variety of ways. However, no matter their training pathway, nurses do not undergo the level of training necessary to independently diagnose and treat complex medical conditions.

Even advanced practice nurses may only complete an additional
2 years of education and training after college.

The extra years of training that physicians receive can mean the difference between life and death. For this reason the Coalition supports continued physician supervision of nurses and opposes SB 695.

Protect Patients OPPOSE SB 240

Legislation has been filed in the NC Senate that puts patients at great risk. Senate Bill 240proposes to eliminate the requirement of physician supervision of nurse anesthetists (CRNAs). North Carolina law has always required physician supervision of nurse anesthetists providing anesthesia medical care. Unfortunately, this important patient safety standard is under attack.

Physician supervision is, and should remain, the law.

The North Carolina Medical Board has always required physicians to supervise nurse anesthetists providing anesthesia services – this helps ensure the safety of services provided. Physician anesthesiologists complete almost double the education and more than ten times the clinical training of nurse anesthetists.

In 1998 and again in 2005, the N.C. Attorney General concluded that North Carolina law requires “the anesthesia care of a patient [must] be under the supervision of a physician.”

In 2005 the N.C. Court of Appeals rejected a lawsuit by nurse anesthetists by finding that “physician supervision of nurse anesthetists providing anesthesia care . . . is a fundamental patient safety standard required by North Carolina law.”

The requirement of physician supervision is supported by multiple academic studies suggesting that physician involvement in anesthesia care improves patient outcomes. Additionally, every hospital in the state requires the supervision of nurses providing anesthesia services.

North Carolina law has always required physician supervision of nurse anesthetists. It should remain that way. We value the important contributions of CRNAs, but a physician-led care team provides the most effective — and safest — care for patients.

* Training Chart Courtesy of ASA “When Seconds Count”

Naturopath Licensing Bill Reappears at NCGA

Almost every year the NC General Assembly is faced with proposed legislation to license naturopaths to practice medicine in North Carolina.  This session is no exception with Senator Stan Bingham filing SB 118 – Naturopathic Licensing Act, last week.

During past debates illegally practicing naturopaths have offered their services as a form of “primary care” – a thought that is troubling to our members. Many patients fail to ask questions regarding the qualifications of their health care provider.  If naturopaths are able to use the title of doctor or physician when practicing this could further confuse the public, presenting the false perception of medical training.

Additionally, licensure of naturopaths as physicians is troubling because:

  • ineffective naturopathic treatments may delay necessary or needed medical services and put patients at risk
  • the lack of ethical standard for naturopaths could lead to patient exploitation through sales directly to patients of “naturopathic remedies”
  • this bill places no limitations on naturopaths when it comes to providing mental health care, treating children, or even diagnosing cancer.

For these reasons the Coalition opposes SB 118 as introduced.