MARVIN MANDEL, Governor

3919

The concept of incorporating into the health care
delivery system providers of direct patient care services
who are not physicians bat who are educated and
experienced in the provision of health services is widely
accepted in the United States and the State of Maryland.

The State of Maryland was the earliest among the 40
jurisdictions to approve changes in the Medical and
Nursing Practices Act to accommodate these new
practitioners.

Experience in the State of Maryland in educational
programs to prepare these health care workers has been
gained at most of the State's leading academic centers in
which education of health professionals is emphasized.
Nurse practitioners have been trained and educated at the
University of Maryland, Johns Hopkins University, and
Union Memorial Hospital. Physician's assistants have
been educated at Essex Community College. Health
Associates have been educated at the Johns Hopkins
University School of Health Services, and beginning in
the Fall of 1975, The Johns Hopkins University School of
Health Services will admit the first students to its new
program in nursing education to prepare these students
from the outset of their professional careers as
experienced capable nurses in this new role. The
University of Maryland School of Nursing has developed
graduate programs for nurse clinicians to function in the
new role.

Experience in different clinical facilities has
shown that these practitioners can function in a variety
of settings to provide a major portion of the patient
care services which respond to the needs for preventive
health care, chronic disease management, diagnosis and
therapy of a majority of common, nonlife threatening, and
self-limited health problems, and advocacy for the
patient in coordination of care and referral to
appropriate sources of specialized care. The quality of
these health services has been at the highest standard,
and the acceptability of the new practitioners' roles by
recipients of health care has been enthusiastic.

The recognition of the status and professional
capability of these practitioners is reflected in the
formation of professional societies and accreditation by
the established professions and qualifying examinations
to certify the competence of the practitioners.

Although the per annum costs of educating such a new
health practitioner are high because of the expense of a
competent clinical faculty in a ratio which approaches
1:1, the total cost of preparing such a practitioner is
much less than the cost of eight to ten years of medical