Advancing scope of practice for advanced practice clinicians: more than a matter of access.

摘要

The declining availability of abortion care has been the topic of many studies, commentaries, conferences and advocacy initiatives over the last 20 years. Among the ideas suggested to ameliorate this problem is increasing the number of physician assistants (PAs), nurse practitioners (NPs), and certified nurse midwives (CNMs) who perform first-trimester abortion [1-6]. While addressing access through this strategy holds great promise, it is not simply a matter of access that calls for more clinicians to participate in abortion care. Rather, as health professionals, we should expect that professional scope of practice determinations are based upon whether the "profession can provide this proposed service in a safe and effective manner" [7] and not solely on the lack of physicians available to provide the service. It is time to acknowledge that PAs, NPs and CNMs [collectively known as advanced practice clinicians (APCs)] are capable and qualified to provide abortion care services, but that current efforts to provide this care are thwarted by both the politics of health care and the politics of abortion [8]. Outdated laws, restrictive regulations, lack of clinical training opportunities, professional turf battles and politically-motivated challenges impede APCs abilities to provide abortion care. APCs, physicians, reproductive health and rights advocates and attorneys must join together to promote the provision of abortion by APCs, thereby protecting both women's access to abortion care and practitioners' rights to provide essential care for their patients.