With many of the reforms envisioned by health activists involving a healthy dose of primary care, it's critical that a growing number of primary care doctors be there to fill the need. But with primary care practitioners on the decline, many states are exploring options that will allow nurse practitioners to fill the gap.
The trend away from primary care is multifactorial in cause, but the numbers are undeniable: Today in the U.S., only 30% of all physicians practice primary care, as compared with about 70% in most other developed countries. As a piece in KevinMD.com notes, few medical students are choosing primary care, older PCPs are retiring early, and many others are closing up their practices or seeking employment at the local hospital.
Certainly there are long-term solutions to this problem, which involve large investments in getting students into a primary care career. But over the short term, it seems more likely that nurse practitioners are the answer to physician shortages. Increasingly, states are considering giving nurse practitioners and other advanced practice nurses more freedom, or have actually gone ahead and changed their laws to do so.
At present, there's no word of a federal bill that would expand the freedom of advanced practice nurses, so if it's going to happen, it will be played out state-by-state. But at least one federal agency has weighed in on the issue already.
In a recent policy paper, the Federal Trade Commission suggests that states should be careful when considering limits to the practice scope of advanced practice nurses.
"Numerous expert health care policy organizations have concluded that expanded APRN scope of practice should be a key component of our nation’s strategy to deliver effective health care efficiently and, in particular, to fill gaps in primary care access," the paper said. "Based on our extensive knowledge of health care markets, economic principles, and competition theory, the FTC staff reach the same conclusion: expanded APRN scope of practice is good for competition and American consumers."
Here's some states where there's action on this front:
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Connecticut: In Connecticut, the state Senate voted earlier this month to allow nurse practitioners to practice independently of physicians. The proposal is now under consideration in the House. The idea is favored by Gov. Dannel Malloy, whose administration has sold it as a way to increase access to primary care at lower costs.
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New York: Starting January 1, experienced nurse practitioners in New York will no longer need to be formally contracted with a physician to practice medicine. According to Modern Healthcare, NPs with more than 3,600 hours of experience will be able to practice without a written practice agreement with the supervising physician.
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Illinois: Last month, Illinois governor Pat Quinn signed a new law amending the Medical Practice Act of 1987. The amendments expanded the role of advanced practice nurses, including nurse practitioners. Under the new law nurse practitioners may now provide services other than those provided by their supervising physician.
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Florida: Last month the Florida Senate passed the bill which would give advanced practice nurses more authority, including prescription of controlled substances, though the requirement that they have an agreement with the supervising physician remains. A separate bill in the Florida Senate would allow NPs to practice without supervising doctor, but doesn't seem likely to pass due to strong opposition from the Florida Medical Association.
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Nebraska: Nebraska legislators have introduced a bill that would eliminate the requirement that nurse practitioners have a practice agreement with doctors to practice medicine. According to the North Platte Bulletin, the requirement that they have a physician supervisor is pushing 70% of NPs out of Nebraska and into neighboring states that have more lenient policies.