In Lake Norman Regional, nurse practitioners replace physicians for newborn care; Group of doctors say it’s “dangerous”
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BIG BOOK IN DEPTH
◼️ Nurse Practitioners Replace Doctors for Newborn Care at Charlotte-Area Hospital in National Campaign to Cut Costs
◼️ Doctors say it’s “dangerous” for babies
◼️ Hospital staff: nurses ‘are better than a doctor’ and ‘more experienced than a pediatrician’
By Michelle Croupton
When you go to the hospital to have a baby, you can assume that a doctor will carefully examine your newborn baby after delivery, making sure that your little one is perfectly healthy.
But if you deliver toLake Norman Regional Medical Centerin Mooresville, this is no longer the case.
In March, the hospital recruited a team of neonatal nurse practitioners to replace pediatricians and certified neonatologists who used to see newborns. This means that there are no doctors doing tests on the babies there.
The changes at Lake Norman Regional are part of a growing national trend to replace physicians with nurse practitioners, sparking vigorous debate over the degree of independence to be accorded to highly qualified nurses.
Advocates say they can lower healthcare costs and give patients better access to care at a time when doctors are scarce, especially in rural areas. But doctors fear that healthcare facilities are using nurse practitioners to cut costs at the expense of patient care.
Doctors protest:Lake Norman Regional’s move prompted more than 200 members of a Charlotte-area women’s physician group to sign letter to CEOClyde Woodask him to reconsider his decision. The letter says critical medical problems can arise quickly and without warning in infants, and that it takes “watchful, well-trained eyes” to spot subtle signs that could mean a health problem.
“A trained physician with years of clinical experience can make the difference between life and death in these situations,” the letter said. “Your decision to replace physicians and neonatologists with nurse practitioners is dangerous and willfully jeopardize the care and well-being of our most precious asset: newborns. “(See the full letter here.)
It is not unusual for small hospitals to staff neonatal care units with nurse practitioners. A small study published in an Oklahoma medical journal found that the quality of care did not decrease under this arrangement.
But it’s unclear how common it is for a medical center to have no doctor at all seeing their babies. The maternities of theNovatingandAtriumCharlotte area hospitals as well asIredell Memorialin Statesville,Piedmont Medical Centerat Rock Hill andCaroMont Regional in Gastonieall have doctors who examine their newborns.
however,Regional Davisin Statesville also relies on neonatal nurse practitioners rather than doctors. Davis Regional and Lake Norman Regional share the same management team and are both owned byCommunity Health Systems Inc., a large for-profit hospital operator.
The hospital responds:Spokesperson for the Lac Normand RegionLeigh whitfielddeclined to answer specific questions from The Ledger or make directors available to talk about the change, but she emailed a series of statements in response to the questions.
She said the maternity center at the hospital provides “safe and high quality care” and noted that the hospital’s neonatal nurse practitioners “are highly specialized in infant care with extensive experience in neonatal nurseries. intensive care ”.
Whitfield said the hospital’s neonatal care center was upgraded from a Level II to a Level I center in March, when nurse practitioners arrived on board. Level I nurseries can only care for the healthiest babies born after 35 weeks gestation.
When babies need advanced medical care, the Lake Norman area transfers them to hospitals in Charlotte and Concord, Whitfield said. The Neonatal Intensive Care Units (NICU) at Carolinas Medical Center at Atrium and Novant Presbyterian are both Level IV, the highest level.
Not enough sick babies:Lake Norman Regional had two neonatologists until last year, when one left for another job. Instead of filling the position, the hospital administrators used temporary workers to fill his shifts. (A practice known in the medical community as “locum tenens”.)
The hospital fired the other neonatologist when he brought in the nurse practitioners. Neonatologists are doctors who specialize in the treatment of newborns, especially those who are premature or sick.
Dr James Zolzer, an obstetrician / gynecologist who gives birth at the hospital, said administrators told him the Lake Norman area did not have enough newborns with serious health issues to warrant keeping neonatologists on staff . According to PayScale, neonatologists earn a median salary of $ 227,943 per year, compared to $ 107,330 for neonatal nurse practitioners.
The ledger asked if the hospital has reduced its newborn care costs, as replacing neonatologists with neonatal nurse practitioners is expected to result in significant cost savings. Whitfield did not answer the question.
NC requires physician supervision:Nurse practitioners are specially trained nurses who have advanced skills and at least a master’s degree. They can order and interpret diagnostic tests, prescribe drugs, and administer treatments, but they have less training and fewer clinical hours than physicians.
At least 22 other states would allow nurse practitioners to practice without medical supervision, and a bill in the legislature would also drop North Carolina’s supervision requirement.
For now, however, the state requires nurse practitioners to be “supervised” by a physician. The law does not say that the doctor must exercise direct supervision; it only requires that doctors have an agreement with the nurses they supervise and meet with them once every six months.
Claims of physician “supervision” disputed:In an email, Whitfield said the hospital’s neonatal nurse practitioners were working “under the direct supervision of a neonatologist.”
This is not true, saysDr Ashleigh Maiers, a cardiologist from Charlotte who was the lead author of the letter to the CEO of the hospital. Or at the very least, she said, the hospital is expanding the definition of “direct supervision.”
Maiers said a hospital administrator told him neonatologists were available to nurse practitioners via telehealth, and that an offsite pediatrician signed patient notes written by nurse practitioners at the end of the day. day, but does not see the babies himself.
“He doesn’t need to touch the baby. He doesn’t even need to talk to the nurse practitioner, ”said Maiers, who had her babies in Lake Norman Regional.
A doctor at the hospital who did not want to be named confirmed the arrangement.
Maiers says it’s also troubling that the hospital isn’t more transparent with patients. On its website, the Lake Norman Regional Medical Center proclaims that its maternity care team “includes competent and board-certified obstetricians and neonatologists.”
What does the hospital say to patients?Ledger called the Lake Norman Regional main number to see what they are telling patients about the level of care newborns are receiving. We were transferred directly to the maternity ward.
The woman who answered the phone said neonatal nurse practitioners are highly trained and work in level IV neonatal intensive care units in Charlotte. “They are better than a doctor,” she said. “I know it sounds scary, but they’re the ones who really take care of these babies. They can place lines, intubate, whatever a neonatologist can do. They are more experienced than a pediatrician with sick babies.
If the nurses have any questions or concerns, she said, they can call a neonatologist or have him come to the hospital.
If a baby is born prematurely or with health problems, staff stabilize the baby and then transfer the child by plane or ambulance to a larger hospital, the woman said. A nurse practitioner stays with the baby.
But if a new mom wants to be with her baby, she’ll either have to transfer or request an early exit from Lake Norman Regional and travel to Charlotte or Concord.
Why don’t pediatricians do baby health checks?When the Ledger asked Whitfield why local pediatricians had stopped visiting babies in the hospital, she hinted that doctors had made the choice to stop: “It’s up to the doctor to choose how he structures his. convenient. When a doctor primarily switches to outpatient care, it means that they have decided not to provide care in the hospital, which includes rounding up patients.
The woman who answered the phone at the maternity ward had a similar explanation: “They decided they didn’t want to come on weekends and in the middle of the night.
It is true that many pediatricians nationwide no longer visit their patients in hospitals. But many hospitals hire a pediatrician to fill this role.
Ledger couldn’t reach any pediatrician who used to visit babies in the hospital. However, a doctor at the hospital told The Ledger that after the nurse practitioners arrived, the hospital told pediatricians they could no longer go to the hospital because the nurses had an exclusive contract.
After the medical community retreated, the hospital relented, but the pediatricians decided not to return. “At that point, they felt like they weren’t welcome,” the doctor said. “The hospital basically kicked them out.”
OB / GYN misses the “security layer”:Zolzer, OB / GYN, said the changes at the hospital will not impact the vast majority of her patients, who have normal pregnancies and healthy babies. But he now has to send some of his high-risk patients to other hospitals for their deliveries. .
He said he gave birth to a patient with a high-risk pregnancy in Lake Norman Regional since the change, and the neonatal nurse practitioner “handled it exactly appropriately – as if a neonatologist had been there. “, did he declare.
Still, he said he would prefer to have a neonatologist in the hospital. “They can handle more complicated issues, and mom and baby can stay in the same facility,” he said. “It’s another layer of security.”
Michelle Crouch is a freelance writer and a regular contributor to The Ledger who writes frequently on healthcare. Send her story tips at [email protected]