Post-pandemic, fix scope-of-practice laws
Even health care answers to the law of supply and demand.
Before the pandemic, demand for care was surging as our nation aged. Supply has not kept up. More than 83 million Americans live in areas where there’s a shortage of primary care health professionals, according to the federal government.
Rising demand coupled with limited supply is a recipe for high prices. And now, with a new variant of covid-19 in our midst, demand for care will only increase.
Relaxing the laws that limit what professionals like nurse practitioners and physician assistants can do would go a long way toward alleviating our immediate supply crunch. In the long run, a freer labor market could yield a more efficient system, with better-quality care and lower prices.
Pre-pandemic, many states enforced restrictions on what nurse practitioners, physician assistants and other non-physician providers could do — despite the fact that they have extensive education and training. Both NPs and PAs earn master’s degrees. Some go on to earn doctorates or other advanced degrees.
When the pandemic hit and hospitals were besieged, many states waived those scope-of-practice rules to permit NPs and PAs to prescribe more kinds of medications, conduct testing, and perform routine procedures.
Nearly two years later, some states are reverting to the restrictive way things were. That is a mistake.
Allowing NPs and PAs to practice more broadly would yield savings. The cost of care for Medicare beneficiaries is 34% lower when being treated by NPs relative to physicians.
Changing scope-of-practice rules is also a much more cost-effective way to expand access to care, particularly for communities suffering from provider shortages. Embracing a definition of primary care provider that includes NPs would lead to a 70% reduction in the number of Americans living in counties with care shortages.
So why did it take a pandemic for us to adopt these rational steps? The doctors’ lobby has for decades fought changes that would broaden responsibilities for anyone without an M.D.
Only physicians, they say, have the credentials to ensure patients’ safety. This is false. Research shows that outcomes for patients treated by NPs are, on average, equal to or better than those of physicians. For PAs, the story is the same.
Demand for health care won’t disappear when the pandemic ends. By 2034, the United States could be short nearly 50,000 primary care physicians. We won’t close this gap simply by recruiting more medical students. The physician workforce is expected to grow by only 3% through the end of this decade.
The growth prospects for other medical professionals are starkly different. Employment for nurses with advanced training and physician assistants is expected to grow by 45% and 30%, respectively, by 2030.
Patients should be allowed to benefit from that growth. Doctors will be just fine.
Some states are beginning to realize as much. For example, Pennsylvania Gov. Tom Wolf signed legislation in October that permanently implements changes to scope-of-practice rules for PAs. More states should follow suit.
Our health care system should always put patient safety first. Ensuring that providers are qualified is in line with that goal. But the truth is that NPs or PAs can handle a significant portion of doctors’ visits.
When it comes to scope-of-practice rules, the pandemic should be a wake-up call, not an anomaly. Let’s make it easier, not harder, for patients to get the care they need.
Sally Pipes (@sallypipes) is president, CEO and Thomas W. Smith fellow in Health Care Policy at the Pacific Research Institute. Her latest book is “False Premise, False Promise: The Disastrous Reality of Medicare for All.”
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