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To the Editor: Dr Cooper and colleagues¹ explore some of the trends of nonphysician clinicians (NPCs) and their march to increase their scope of practice, but stop short of analyzing what impact this "high degree of autonomy" will have on patient care. While much can be learned through hindsight, the public cannot afford to have the medical community take a wait-and-see attitude in this matter.

As president of the American Society of Anesthesiologists, our organization and I have substantial experience with efforts by certified registered nurse anesthetists (CRNAs) to expand their scope of practice. The stated intention of CRNAs, to be able to practice independently of any medical supervision, should make it clear to physicians in primary care and specialty practices alike that many "nonphysician clinicians do not aspire merely to complement physicians," as Drs Grumbach and Coffman noted in their Editorial.² If NPCs want to improve patient care, as . . . [Full Text of this Article]

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