Power To Prescribe Widens

The number of drugs prescribed by nurse practitioners and physician assistants is rising dramatically, reflecting their increased legal authority and growing acceptance by doctors.

Nurse practitioners wrote 15 million prescriptions in the United States last year, up 66 percent from 1997, according to a study by the consulting firm Scott-Levin. Physician assistants wrote 12 million prescriptions, up 33 percent.

While those numbers still represent a fraction of the 2.5 billion prescriptions written annually, consumer and medical groups say the trend aids patient convenience and makes doctors offices more efficient.

"The increase in scripts reflects the increasing numbers of nurse practitioners and physician assistants working with doctors," said Dr. Thomas Reardon, president of the American Medical Association.

Physician assistants, who practice medicine under a doctor's supervision, can write prescriptions in 46 states, almost twice as many as a decade ago. States not granting them legal authority are Louisiana, Mississippi, Indiana and Ohio.

Nurse practitioners -- registered nurses with advanced, specialized training -- can write prescriptions in all 50 states, although in Pennsylvania, Georgia, Michigan and Ohio, a doctor is required to co-sign the order.

Some doctors argue these caregivers lack enough education to prescribe medicines, but proponents say the option makes doctors available to work on more complex cases and saves patients time.

About 34,000 physician assistants and 60,000 nurse practitioners work in the United States. The two specialties began in the 1980s as a way to complement physicians and offer a less expensive alternative to help busy practices and hospital clinics.

As managed care has reduced doctor fees -- pushing them to see more patients to maintain their incomes -- doctors increasingly rely on nurse practitioners and physician assistants. At least one health maintenance organization, Oxford Health Plans, lets its New York City members choose a nurse practitioner as their primary caregiver.

All states require doctors to supervise physician assistants, and most nurse practitioners also do much of their work with doctors. Some states prohibit nurse practitioners and physician assistants from ordering highly addictive drugs or controlled substances.

Having the ability to write prescriptions speeds the patient through the office, said Bill Kohlhepp, a physician assistant at the Hospital of St. Raphael in New Haven, Conn., and president of the American Academy of Physician Assistants.

As doctors become more comfortable with physician assistants, Kohlhepp said, they realize the assistants aid their practice by giving them more time to handle the difficult cases.

"Physicians used to look at prescribing drugs as the one thing that separates them from other people," he said. "They initially thought they would be giving something up."

Written By Phil Galewitz