The definitive word on medical practice in America -- the highly respected and impartial Institute of Medicine (IOM) of the National Academy of Sciences -- has weighed in on this idea of allowing APRNs to do more, in a landmark 2010 report "The Future of Nursing." The IOM conducted an exhaustive review of all the available studies of the efficacy and safety of care provided by APRNs and concluded that properly trained APRNs can independently provide core primary care services as effectively as physicians. They can provide wellness and preventive care services, diagnose and manage common, uncomplicated acute illnesses, and help patients manage chronic diseases such as diabetes. In its report, the National Academy of Sciences recommended that "[a]dvanced practice registered nurses should be able to practice to the full extent of their education and training."

But despite an urgent need and clear evidence that APRNs can complement and extend primary care providers' roles -- without sacrificing quality of care -- nurses are only permitted to practice independently to the full extent of their training and competence in 16 states and the District of Columbia. The remaining states impose regulatory barriers that limit their scope of practice. These barriers should and can be removed.

But the turf wars of organized medicine are preventing progress. The American Medical Association, the American Osteopathic Association, the American Academy of Pediatrics, and the American Academy of Family Physicians all oppose expanding the scope of nurse-practitioner responsibilities, despite the IOM report and recent research demonstrating that an expanded scope of practice for APRNs has no impact on primary care physician income.

In Colorado, where there are far too few anesthesiologists available for rural and critical access hospitals, the state's medical and anesthesiologists societies sued to overturn former Governor Bill Ritter's 2010 decision to allow Certified Registered Nurse Anesthetists (CRNAs) to provide anesthesia and pain management care in these hospitals. Instead, they prefer to make people travel hundreds of miles out of their communities to have a procedure that a CRNA is licensed and trained to carry out. They are also apparently fine with hospitals being forced to close as a result of a lack of anesthesiologists. This is a classic example of doctor-centric care trumping patient-centric care.

Apparently the physician organizations are threatened by some mix of concerns about lost income and their traditional position as "captain of the ship." Those opposed to expanding the scope of nurses' practice also argue that physicians with more years of training under their belts must necessarily know more than an APRN ever could. Of course they know more, but it is well established that they do not know more about providing the core elements of basic primary care.