There are few topics in medicine that are getting as much legislative attention as scope of practice.
During the Politico event titled “Pro Health Care Breakfast Briefing: Defining the Scope of Practice”, moderator Joanne Kenen remarked that in 2011 and 2012 alone there were 1,795 bills related to scope of practice rules in the various states.
In 2013, there have been 144 scope of practice bills proposed across 33 states, according to the National Conference of State Legislature. Of those bills, 115 are related to nurse practitioners.
Scope of practice is a hot issue for a variety of reasons, but the biggest is the Affordable Care Act (ACA), which will add extend healthcare insurance coverage to 30 million previously uninsured Americans. This surge in patients threatens to exacerbate an already strained primary care physician workforce. The American Academy of Family Physicians estimates that the United States faces a shortage of 60,000 primary care physicians overall by 2020.
One of the proposed solutions to the primary care shortage is to lift restrictions that some states have placed on midlevel providers, particularly nurse practitioners (NP). In many states, NPs are not allowed to practice to the extent of their training.
Donna E. Shalala, Former Secretary for the Department of Health and Human Services, said placing restrictions on nurse practitioners is counter-productive. States have invested a lot of money into training NPs to a certain level, and to suggest they can only practice to a level that is below that standard is inappropriate, Shalala said.
Although NPs are interested in the ability to perform more services without physician supervision or a collaborative agreement, the panel emphasized a team approach is still needed to address the primary care crisis. The that end, Wanda Filer, Director of the AAFP said the association does not believe that independent practice for NPs is in the best interest of patients.
Filer said that NPs operating as stand-alone providers would further fracture healthcare system. Instead NPs should continue to practice as parts of a primary care teams that are led by a primary care physicians. In fact, she said a team of four NPs working with every primary care physician would eliminate many of the primary care access problems in the US.
Angela Golden, President of the American Association of Nurse Practitioners (AANP) agreed that collaborative care is needed, but added the AANP does not support regulations that require NPs to be supervised by another provider. Doing so would create an additional barrier between the patient and the care that can be provided and would prevent NPs from leading their own care team. She added that in many cases, NPs provide care that is equal to that of physicians.
With so many bills already in the system, we may see some changes in the states that restrict NP practice. For more information on NP scope of practice, check out our NP Scope of Practice Law Guide.
