Apa

I recently had the opportunity to sit down and chat with Dr. Katherine Nordal from the Coalition for Patients’ Rights. She has also been the Executive Director for Professional Practice at the American Psychological Association (APA) since April 2008. She talked with me as a spokesperson for the Coalition for Patients’ Rights.

Dr. John Grohol: To get started today, can you tell me a little bit about your professional background?

Dr. Katherine Nordal: I came to the APA from Mississippi where I had been in independent practice for 28 years. I owned my own clinic. It was a small group practice. We had a rather diverse practice, everything from individual patient services to business consultation to working with the fire department and police departments and sheriff’s departments around fitness for duty issues. We worked with the nuclear power industry some, and I had a pretty good size personal injury forensic practice when I left Mississippi.

I had also been involved at APA previously on its board of directors. I was actually chair of the Committee for the Advancement of Professional Practice when Russ Newman resigned from APA. I ended up applying for that position [when Newman left] and was the candidate selected by Norman Anderson to be the next executive director for Professional Practice here.

Dr. Grohol: So tell me a little bit about the Coalition for Patients’ Rights.

Dr. Nordal: The Coalition for Patients’ Rights is actually a group that we got involved in really before I even came to APA, I think, to some extent. That is that we’ve got a Public Relations campaign going on now that is relatively new. But the Coalition started back in 2006. You may be aware, I know I was aware, for example in Mississippi, when I would see ads on the morning news that they’d have a mental health story and then they’d break away to a little side bar that would say the only real doctors that treat depression are your physicians or something like that and give you a link to the State Medical Society website. There is a scope of practice partnership, which is a coalition so to speak, of medical and osteopathic physicians and it was funded, I guess, and started by the AMA in an effort to restrict the scope of practice to all other healthcare professionals. That included chiropractors, and optometrists, and nurse midwives and advanced nurse practitioners including nurse anesthetists. I mentioned midwives.

It wanted to restrict their scope of practice and not allow them to practice within the full range of their licensure or certification. The Coalition for Patient’s Rights, which includes some 35 healthcare organizations that represent more than three million licensed healthcare professionals including psychologists, came together in an effort to respond to, or be responsive to, the scope of practice limitations that medicine was pursuing on a state by state level.

They continue to try to pursue it at state houses across the country, when other healthcare professions try to increase their scope of practice for things that they are appropriately credentialed to do, for example, psychologists who are appropriately trained to provide prescriptive privileges.

Dr. Grohol: Can you give me an example of where lobbyists or someone from an organization is trying to restrict the scope of practice of a profession?

Dr. Nordal: I think one very obvious one for us in psychology has been around the prescriptive authority agenda. We have been fought, pushed back with a lot of money and a lot of folks from the medical community. It sort of comes from psychiatry, but it really has the backing of the entire medical community in an effort to prevent psychologist’s prescriptive authority statutes from being implemented in states. That would be one. There have been — I know of some efforts, in fact I was meeting this morning around some other issues with the Chief Government Relations folks from the American Nursing Association, and they have very similar kinds of issues with advanced nurse practitioners trying to have an increased scope of practice with the physician community fighting that along the way. Whether it’s being able to be a primary care provider, which incidentally, there was a bill passed this year in Hawaii that allows advanced nurse practitioners to be primary care providers and they do not have to be, apparently, overseen by physicians.

There are problems with the nurse anesthetists have had difficulties with the anesthesiologists trying to limit their scope of practice; the nurse practitioners with physicians trying to limit their scope of practice. We know there have been, were horrendous battles earlier on when optometrists tried to get even limited prescriptive authority even for eye drops and things of that nature and medicine fought the optometrists on that.

So I don’t personally have a laundry list of all of those things, but I’m sure there are other groups within the coalition we could put you in touch with if you wanted some more specific case examples.

Dr. Grohol: No. I just wanted to get an idea because it really sounds as if it’s physicians battling all of these other professions.

Dr. Nordal: Well, it is. It’s both physicians and osteopathic physicians. I was going to say, another group that has had some problems has been pharmacy. Pharmacists have historically provided a lot of counseling for patients that come in to have prescriptions filled.That’s not been so much of a problem, but apparently in some states, some PharmD’s, they’re called, do have some limited prescriptive authority or have advocated for that in some areas. There are some states where pharmacists are actually doing immunizations for flu and bronchitis and that sort of thing with adults. And medicine has, from what I understand, fought that as well saying that pharmacists are not appropriately trained to be providing those kinds of immunizations in the drug stores.

Dr. Grohol: So when it comes down to patient’s rights, and patient choices, it sounds as if this is really about helping to meet patient’s needs at different levels and different costs that makes it more readily available to them.

Dr. Nordal: Absolutely. I think certainly that there are a lot of physician providers in this country and they do provide very good quality health care. But there are also more than three million other appropriately licensed and trained healthcare providers from the masters level up through doctoral level that can provide very safe, effective, in some cases more cost efficient care than may be provided in a physicians’ office.The Coalition believes that patients should have access to the right treatment at the right time with the right provider or the provider of their choice in so far as that provider is appropriately licensed or credentialed by a state authority to provide the services for which they were educated and trained.

Dr. Grohol: So can you talk a little bit about what the Coalition is doing to protect patient rights to access and choice?

Dr. Nordal: Well, Sophie may be able to tell you a little bit about this, but the first thing I think is, the most major thing they’ve done, is make a commitment to this public relations campaign. I know I was at the White House last week, the APA was invited to come and participate in a discussion with Nancy-Ann DeParle, who is Obama’s kind of White House healthcare czar. She’s been meeting with a lot of stakeholder groups. The groups that met last week when I was there included pharmacy, nurse midwives, advanced nurse practitioners, optometrists, the American College of Physicians and Surgeons, and the physician’s assistants.

We heard a lot of “the right treatment at the right time by the right provider” from those individuals as well, with an appreciation, I think, that as we have this opportunity to hopefully reform our health care system, i.e. really reform the way in which we deliver care, not just reforming payment systems, that there is an appreciation that patients have a variety of different needs that can be adequately addressed and met by a variety of different healthcare providers.

And we feel that the inclusion of these providers at a level, again, appropriate to their education, training, and licensure, is a good way to deliver more effective, more efficient, and more affordable healthcare to folks across the country.

So that’s the message that I think different members of the Coalition are trying to get out, probably in different venues. And I don’t know if Sophie may have any more information about any specific activities of the coalition or not.

Sophie Bethune: We also had the Coalition wrote to the Obama Administration to introduce the Coalition and the aims and to kind of be part of the process of looking at healthcare reform, and sent a similar letter to members of Congress. I can get you copies of both of those if you’re interested, and you haven’t already seen them.

Dr. Grohol: Yes, that would be great, thank you. So, it’s really been a focus, it sounds like, and an effort with a public education campaign to try and educate people about why this is important and why they may want to get involved and support this effort.

Dr. Nordal: Sure. And I would say, too, John, I don’t know about you but I’ve lived in a semi-rural area or a semi-suburban part of it, not too far from the Mississippi State Capital, but it’s not a very populated area of the country. Parts of it are extremely rural. I can tell you just from my personal experiences that there are many health care providers that are extremely valued by consumers of health care.Physicians are not the only ones who can provide health care. The AMA’s effort, and pretty aggressive effort, at being right out there marketing themselves, i.e. physicians, as the only provider that can provide health care to people is really what was the stimulus to get this coalition going, because we know that’s just not true. And we know that consumers know that that’s just not true.

Until the coalition was put together, there was not a voice that was responding to the messaging that was being put out by this coalition of physicians and the osteopathic physicians and medical physician group.

Dr. Grohol: How do you respond to critics that talk about whether this is protecting patient’s rights to access and choices or whether it’s really more of a professional turf battle?

Dr. Nordal: I think the professional turf battle was started by the physicians when they decided to inform the American public that nobody could provide healthcare but physicians. And again, this is the information that the Coalition is putting out. It’s not anti-physician information. It’s not saying that physicians are not qualified providers. They are, according to their scope of practice.It’s just to make sure that consumers have information that they may need and it would be helpful to them in making their own choices about healthcare providers that they may want to seek out for different reasons. For example, a pregnant woman might choose to see an OB/GYN, or she may chose to go to her primary care family doc, if they are even still doing OB, which many of them aren’t anymore because of the malpractice premiums, or they may choose to go to a nurse practitioner, or to go to a nurse midwife.

We believe that women should have that choice. If they are more comfortable, and like the kind of care that a nurse midwife can provide during pregnancy, during delivery and after that delivery, and if that’s a set of skills that nurse midwives are qualified to provide, I think women should have the choice of going to a nurse midwife instead of going to an Obstetrician to have her baby delivered if that’s what she wants to do. And she needs to know that that nurse midwife is an appropriately trained and credentialed provider who can provide her with a safe and effective prenatal care and delivery and a good outcome from birth, just as a physician might be able to do.

Dr. Grohol: And so the Coalition would ideally like to get some of this into the Obama Health care plan?

Dr. Nordal: Yes. That was the purpose, I think, of the letter and the information that has been sent. I know from at least that one White House conference that I attended last week, that there is a lot of talk among the other health care provider groups. We’ve seen this with information that is coming out in some of the health care bills. There is a lot of talk about truly integrated healthcare.I think truly integrated healthcare means that it’s back to the right treatment for the right patient at the right time by the right provider. And it recognizes that we all have a continuum of different kinds of healthcare needs and there are many providers in the healthcare network that can provide those things. It is in the country’s best interest to have integrated care where we can treat the whole person and treat them in a more effective and efficient and cost effective manner.

Dr. Grohol: Sure, that makes sense. If someone is reading or listening to this interview and they want to get more involved or do something, is there anything that an ordinary consumer can do?

Sophie: Go to our website for more information. A person can also certainly write to their congressmen as well, but we haven’t developed materials along those lines yet. We’re in the beginning of taking the message out mainly to the policy-making community.

Dr. Grohol: Thanks.

Dr. Nordal: This public relations effort with the community just started this year. Now I will say certainly though, the messages of the Coalition in terms of the integrated care and the affordability and accessibility and patient choice of provider and that sort of thing, that information is widely distributed at least from our perspective, through our public education campaign network. We have been working through that network here in practice in helping to disseminate our healthcare messages out to our members. We are using some social media and social networking as well hopefully with a plan to begin to get these messages out to consumers and consumer groups as well, in the future.

Sophie: Actually, that’s something else worth mentioning. There should be a Facebook page launched within the next week or so, and that is something that consumers could join and get more information.

Dr. Grohol: That’s all the questions that I had. Was there anything else that you thought was important that I didn’t ask and you’d like to mention?

Dr. Nordal: I just take a point of personal privilege, John, since both you and I are psychologists. We probably need to put something in there about wanting to be sure that people had their choices of providers for their mental healthcare too, so certainly that’s why psychology is involved. We certainly value the work that we do as psychologists. We think we bring a very valuable set of skills to both the mental health and to the physical health care setting in terms of prevention and working to prevent chronic disease and working with patients that have chronic disease to manage their disease better and live healthier lifestyles. We certainly do not believe that we should be left out of that loop and we feel, as you well know, very well qualified to work around a variety of physical and mental health issues with patients and believe that patients should have access to psychologists just as easily as they may have access to physicians or psychologists for those kinds of issues.

Dr. Grohol: Thank you very much for agreeing to speak with me today about the Coalition for Patients’ Rights. It was interesting learning about the effort.

Dr. Nordal: It was my pleasure.