Washington, DC - Stephen R. Permut, MD, JD Board Chair, American Medical Association:

"The American Medical Association (AMA) is disappointed by the Department of Veterans Affairs' (VA) unprecedented proposal to allow advanced practice nurses (APRN) within the VA to practice independently of a physician's clinical oversight, regardless of individual state law.

"While the AMA supports the VA in addressing the challenges that exist within the VA health system, we believe that providing physician-led, patient-centered, team-based patient care is the best approach to improving quality care for our country's veterans. We feel this proposal will significantly undermine the delivery of care within the VA. With over 10,000 hours of education and training, physicians bring tremendous value to the health care team. All patients deserve access to physician expertise, whether for primary care, chronic health management, anesthesia, or pain medicine.

"There are many examples from across the nation demonstrating that physician-led team-based care results in improved access to high-quality, cost-effective health care. From patient-centered medical homes to some of the nation's largest health care systems, physician-led interprofessional team-based health care has proven to be a successful model in the delivery of health care. The nation's top health care systems rely on physician-led teams to achieve improved care and patient health, while reducing costs. We expect the same for our country's veterans, and look to these systems as evidence that physician-led, team-based models of care are the future of American health care.

"The AMA urges the VA to maintain the physician-led model within the VA health system to ensure greater integration and coordination of care for veterans and improve health outcomes."