Time to Rollback Healthcare Scope of Practice Laws
Last week, both New York and Kansas granted nurse practitioners the freedom to practice independently, without the supervision of a physician. The Empire State and the Sunflower State are now the 25th and 26th states to roll back “scope-of-practice” restrictions on NPs.
This trend is worth celebrating. The shortage of primary care doctors in the United States is already at crisis levels, particularly in rural areas. Empowering NPs, physician assistants, and pharmacists to treat people independently could expand the supply of health care virtually overnight — at little to no cost.
America’s primary-care shortage long predates the COVID-19 pandemic. An analysis by the federal government from 2019 found that an additional 13,758 primary care doctors would be needed to meet demand in places around the country designated Health Professional Shortage Areas.
A separate study based on data from that same year projects that America could be short as many as 124,000 doctors by 2034. And those estimates don’t reflect the consequences of COVID-19 on the nation’s healthcare resources.
Yet even as an alarming number of Americans struggle to find care, many states still place onerous limits on what non-physician medical professionals can and can’t do to help patients.
Twenty-four states either reduce or restrict the ability of NPs to engage in at least one element of practice. The law in these states may require NPs to enter into a career-long agreement with another healthcare provider in order to deliver care, or to submit to career-long supervision.
That makes little sense, given how much training NPs go through. First, they must gain experience as a registered nurse. Then, they must undergo years of additional education to earn a master’s or doctorate and pass national boards in a specialty area. They’re also subject to regular peer review and clinical outcome evaluations.
Still, some argue that NPs offer lower-quality care than physicians — and may even endanger the health of patients. The evidence suggests otherwise.
For instance, a 2017 study found that NPs provided higher-quality care — at lower cost — than physicians when treating Medicare patients suffering from diabetes. A 2018 study in the journal Medical Care found that patients treated by NPs had lower rates of hospital admissions, readmissions, and inappropriate emergency department use compared to those treated by doctors.
Meanwhile, loosening scope-of-practice restrictions on NPs has been shown to increase the frequency of check-ups among patients and reduce the need for emergency care while having little effect on patient safety.
This body of evidence could help explain why state and federal governments were so quick to loosen scope-of-practice restrictions for NPs during the early months of the coronavirus pandemic. But why reserve this common-sense measure purely for historic health emergencies?
To date, the main proponents of scope-of-practice restrictions have been physicians — or at least the physicians’ lobby. But these restrictions don’t serve the interests of doctors. If anything, empowering NPs — as well as physician assistants and pharmacists — to perform at the height of their training will free up doctors to focus their energies on more complicated cases.
By contrast, when too much of a doctor’s time is devoted to providing flu shots, calling in medication refills, and other tasks for which they are vastly overqualified, the supply of medical care contracts. Treatment delays grow longer. And patients suffer.
Scope-of-practice laws are a prime example of how heavy-handed government intervention in the health sector can result in shortages and needless human suffering. New York and Kansas were right to do away with them. More states should follow suit.