Md. should make nurse practitioners independent

Nurses are probably already the hardest working people in health care. Nurse practitioners -- highly trained professionals who increasingly function as doctor proxies -- are surely going to be part of the solution to the health care crisis. Especially if pay for primary-care doctors continues to lag that of specialists. In 2008 median primary-care doc pay was $186,000, according to the American Medical Association. Some primary care docs make much less and have hundreds of thousands of dollars in student loans to pay off. So fewer and fewer med school students are going into primary care, even though primary care docs -- who keep people well instead of treating people after they get sick and charging for procedures -- are what the system needs.

Nurse practitioner pay, at a median of $83,000, according to salary wizard, is approaching that of primary-care docs.

It's nice that the General Assembly cut the paperwork needed to become a nurse practitioner. But it will do little to increase medical expertise where it's needed. The legislature should have allowed nurse practitioners to eliminate ties to doctors altogether and practice on their own. But it caved to pressure from Med Chi, the Maryland doctor trade group concerned to preserve the monopoly of licensed physicians. Washington, Oregon, Alaska and seven other mostly Western states (rural states where docs in the backcountry are scarce) already allow independent N.P. practice. So does the District of Columbia.

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