Here & Now

Dr. Don Lee on Requirements for Advanced Practice Nursing

Frederica Freyberg:

Some physicians say they are wary about the bill and want more patient protections, including our next guest, Dr. Don Lee, president of the Wisconsin Medical Society. Doctor, thanks very much for being here.

Don Lee:

Thank you for having me.

Frederica Freyberg:

So why doesn’t the Medical Society support this bill in its current form?

Don Lee:

Well, first, let me say I’m just so happy to be here. I’m proud to be a physician and part of it is just letting the public know that we’re here for you regardless, that we care about patients. I wanted to be a doctor since I was five years old and learned how to spell anesthesiologist. My dad is a practicing — was a practicing anesthesiologist in La Crosse and loved every minute of it and felt medicine was the best profession and I wanted to follow in his footsteps. He told me to study hard, so I did. I’m here to defend our medical profession because this is what we do is to save lives and help patients.

Frederica Freyberg:

And so are you suggesting that doctors have such a high bar to become a licensed physician that it’s not right that these other kinds of registered nurses, the advanced practice registered nurses should have parity?

Don Lee:

No, not at all. We – I work with APCs, advanced practice clinicians which includes APRNs, and it has been great. I also work with RNs, and there’s not just a physician shortage critical, but there’s a critical nursing shortage also. What I’m saying is it’s hard to compare medical school with a master’s degree nurse practitioner and it’s hard to compare residency, where we don’t see patients by ourselves. We’re in an academic center where an attending oversees all of our work and we have to pass a medical licensure, step one, step two, step three, to even practice independently. So I didn’t practice independently, if you will, until I was 32.

Frederica Freyberg:

And so supporters say requiring four years of real world, team-based experience instead of the two that’s in this bill boxes out advanced practice registered nurses. Why is that level, that four years of experience needed in your mind?

Don Lee:

Our position is to require four years of real-world, team-based care experience before an APRN can advance to practice independently. Current law does not allow that. We have moved. We are — not for the — we support not the status quo — if you get what I’m saying. Like we have moved in supporting independent nursing practice with modifications.

Frederica Freyberg:

Do you think that patient care safety is at risk under the proposal that’s being considered right now?

Don Lee:

Right. So there’s been a lot of studies about cost and quality of care, and I want to cite — and I want to cite the National Bureau of Economic Research in November 2022, the productivity of professions evidenced from the emergency department visits, and they use three years of veterans health and measurements of emergency department visits, and it finds that NPs use more resources and achieve worse outcomes than physicians, especially when dealing with complex patients, but as a physician, me personally right. I see a physician as my primary care doctor. My dad, if he has a physician, but I get it, there’s a physician shortage. It could take three to six months to see his physician so he sees an APC, which is earlier, but that APC is working directly together with a physician that introduces herself as I work with this physician and this bill would completely up end that.

Frederica Freyberg:

What about those collaborative agreements? You think that’s important?

Don Lee:

I mean, if I’m working with an APC, I and that APC are going to work our butt off to provide the best patient care. Doctors are not in healthcare to simply make money. That’s not why we became doctors. And so the vast majority of physicians work collaboratively, work with team-based care with nurse practitioners and APCs to help patients.

Frederica Freyberg:

Dr. Lee, thanks very much.