ROLES OF NONPHYSICIAN CLINICIAN AS AUTONOMOUS PROVIDERS OF PATIENT-CARE

Studies were undertaken to assess the practice prerogatives of nonphys ician clinicians (NPCs) in 10 disciplines that, collectively, are the major nonphysician contributors to the delivery of medical and surgica l services. These disciplines include nurse practitioners, physician a ssistants, nurse-midwives, chiropractors, acupuncturists, naturopaths, optometrists, podiatrists, nurse anesthetists, and clinical nurse spe cialists. Marked differences were found in the practice prerogatives t hat states granted NPCs in the various disciplines. For most disciplin es, the magnitude of their prerogatives correlated with the numbers of NPCs practicing in each state. At their maximal levels, state practic e prerogatives authorized a high degree of autonomy and a broad range of authority to provide discrete levels of uncomplicated primary and s pecialty care. The recent growth in these prerogatives is fostering ne w opportunities for NPCs; however, it also is creating a pluralism tha t has the potential to further fragment the US health care system. It is time for regulatory integration and professional collaboration so t hat a health care workforce that includes a diversity of disciplines c an be assured of providing a coherent set of patient care services in the future.