Approximately 84 million Americans live in “primary care care professional shortage areas” where there are not enough primary care physicians to meet the needs of patients. This includes more than 7.8 million patients living here in California.
Only 25 states have “full practice” rights to nurse practitioners or NPs who can address this issue immediately in the face of this shortage.
In the remaining states, the “Scope” law prohibits NPs from assessing patients, ordering and interpreting diagnostic tests, and managing treatment. States with such curbs include progressive California, retired Florida, and seemingly freedom-loving Texas.
By abolishing these outdated laws, the state can end this relentless waste of talent and increase access to patients’ primary care.
Not surprisingly, some of the states that limit the scope of NP practice are lacking in primary care. In Texas, for example, 228 of the 254 counties in the state are in short supply of primary care care professionals.
The country’s lack of primary care is only ready to get worse. The American Association of Medical Colleges predicts that there will be a shortage of 48,000 primary care physicians by 2034.
Abolishing the coverage law can reduce the number of Americans living in counties with a shortage of primary care providers by 70%.
Physician groups such as the American Medical Association oppose significant relaxation of medical professional coverage restrictions such as nurse practitioners and doctor assistants.
Their opposition can be understood from a purely economic point of view. It’s no wonder that a group of experts try to ban potential competitors to protect the rewards of their members.
But that’s not true. Patients ultimately pay the price of restrictions on government-enforced care provision in the form of longer waiting times for doctors, ration-based care, and higher prices.
Advocates of coverage rules say they inevitably provide poor quality care because they protect patients from less skilled care providers than doctors.
But research does not support it. Studies show that there is no difference in results between patients treated by a nurse practitioner or doctor’s assistant and those treated by a doctor. A 2018 study found that diabetics who received primary care from a nurse practitioner were less likely to be hospitalized than their doctor’s primary care provider.
A January report from the National Bureau of Economic Research concluded that expanding the practice of nurse practitioners would not compromise the quality of care. But, as a paper published in health economics earlier this year concludes, it has the potential to lower health care costs.
Nevertheless, efforts to thwart the scope reform bill have been successful in many states. In 2021, bills aimed at relaxing restrictions on nurse practitioners and other healthcare professionals were breached in Florida, Kansas, Kentucky, Louisiana, Maine, Mississippi, Tennessee, and Texas.
Nevertheless, some states are making progress. Arkansas General Assembly voted to recognize NP as a primary care provider. In New York, Governor Kathy Hokul has included measures to facilitate doctors’ monitoring of nurse practitioners in this year’s budget.
More states should follow. Demand for primary care providers is expected to grow by 20% over the next decade, further widening the supply-demand gap. Nurse practitioners have the skills to fill that gap quickly and affordably.
Sally C. Pipes is President, CEO, and Healthcare Policy Fellow of the Pacific Research Institute.
