On behalf of the Virginia Academy of Family Physicians (“VAFP”), we are writing to provide comment as the Joint Boards of Medicine and Nursing consider regulations to carry out House Bill 793.  The VAFP represents nearly 3,000 family physicians and family medicine residents across Virginia.

In commenting regarding the topics specifically under consideration at the Joint Boards upcoming meeting, VAFP respectfully requests that you consider the following:

Equivalent of at least five years of full-time clinical experience
• VAFP’s position is that the quality of the five year’s of full-time clinical experience is equally important to the quantity of the experience.  After medical school, physicians achieve post-graduate, formal, structured training in medical residency programs.  Some physicians go on to complete additional formal, structured training in fellowship programs.  The Joint Boards regulations in this area should seek to ensure the quality of the nurse practitioner’s five years of full-time clinical experience mirrors the quality of a medical residency program as closely as possible.

Routine practice in a practice area included within the category for which the NP was certified and licensed
• VAFP’s position is that it is fundamentally important for there to be alignment between the attesting physician’s board certification and the category for which the NP was certified and licensed.  For instance, a Board certified family physician should attest to a family practice nurse practitioner’s qualifications for independent practice.  It would be inappropriate for a family physician to attest to a nurse practitioner practicing in an acute care setting, such as cardiology.  Likewise, it would be inappropriate for a cardiologist to attest to a nurse practitioner practicing in a family practice setting.  Additionally, “routine,” as set forth in line 342 of House Bill 793,  should be defined to ensure that the physician and the nurse practitioner have robust overlap in their physical presence during their interactions with their common patient population in order to promote the collaboration and training necessary to empower the nurse practitioner to practice independently.

Requirements of an attestation of practice
• VAFP’s position is that the physician attestation should include, in addition to the stated requirements of Lines 339 – 345 of House Bill 793, significant detail regarding the patient population served by the attesting physician and the nurse practitioner, a description of the amount and nature of collaboration between the physician and the nurse practitioner while serving the common patient population, and any recommendations by the attesting physician for  limitations on the nurse practitioner’s independent practice.

Fee associated with submission of attestation and issuance of autonomous designation
• VAFP has no position on the appropriate fee associated with an attestation and application for independent practice.

Acceptance of “other evidence” demonstrating that the applicant met the requirements
• VAFP’s position is that the Board should maintain a very conservative standard for other evidence, in lieu of a physician attestation, satisfactory to justify independent practice.  Absence of a physician attestation may be indicative that the non-attesting physician has reservations regarding the nurse practitioner’s readiness for independent practice. VAFP strongly recommends that the Joint Boards require that a statement be sought from a non-attesting physician so that the Joint Boards may fully evaluate the circumstances of the nurse practitioner’s application for independent practice. 

Endorsement of experience in other states
• VAFP’s position is that the standard for endorsement in other states should mirror the standards for the composition of the five years of full-time clinical experience established for Virginia-based nurse practitioners. The attestation should require a similar accounting of both these clinical hours and their composition.
 

Unprofessional conduct – falsification of attestation
• VAFP’s position is that falsification of an attestation constitutes unprofessional conduct and should subject the offending nurse practitioner to disciplinary action by the Joint Boards.

The VAFP appreciates the opportunity to provide input into the Joint Board’s regulatory development process.  Thank you for your efforts to ensure that the regulatory framework established to implement House Bill 793 best protects the health and safety of all Virginians. 

Respectfully,

Rupen Amin, M.D.        Jesus Lizarzaburu, M.D.
President, VAFP           Legislative Chair, VAFP