by Ashley Bender
The United States needs a solution to address the country’s need for basic care. More and more people will require effective and adequate primary healthcare options as the general population ages and millions of uninsured people enroll in the Affordable Care Act’s health exchanges. This means the current shortage of primary care doctors in the United States is likely to increase dramatically.
The solution is to expand the scope of nurse practitioners’ authority. Nurse practitioners are trained to diagnose and treat physical and mental conditions by taking medical histories, conducting physical exams, and interpreting diagnostic tests. They should have the legal authority to practice to the extent of their education and training. In order to provide cheaper, more accessible treatment options for millions of patients, states should allow nurse practitioners to treat patients directly, without physician oversight.
Only seventeen states and the District of Columbia allow nurse practitioners to treat patients without physician oversight. Physician advocacy groups, which seek to prevent other states from adopting similar laws, claim that the changes will harm patients and decrease quality of care. But not one state that allows nurse practitioners to treat patients without physician supervision has reported an increase in patient deaths.
On the contrary, the advantage of such expansion – that patients in those states have access to more affordable primary care – cannot be overstated. For example, only sixteen of California’s fifty-eight counties have enough physicians to meet the federal government’s recommendations for physician supply. The dearth of primary care physicians throughout the country leads to primary healthcare deserts: geographic pockets that are unable to attract medical professionals.
The thirty-four states that allow a nurse practitioner to treat patients only under physician supervision differ in the way nurse practitioners are allowed to prescribe medications and bill for services, according to the scope-of-practice laws of the individual state. Some states require physician oversight when a nurse practitioner prescribes medication, while others require physician oversight for treatment as well as prescribing medication. However, any physician supervision is too much when the supply of physicians available for supervisory roles does not adequately cover the patient population. The requirement of physician supervision offsets the potential benefit of additional qualified medical professionals capable of primary care.
The Institute of Medicine, the National Governors Association, and the National Institute for Health Care Reform all reported that expanding the scope of nurse practitioners’ primary care role will help offset the shortage of primary care physicians. Critics of this health system policy change say that substituting a nurse practitioner for a full-fledged physician is “singular and shortsighted” due to the different training backgrounds of the two intertwined professions. However, when the alternative is inadequate primary health care for millions of people, nurse practitioners should, in all fifty states, be given full autonomy to treat patients, prescribe medication, and bill insurance companies for the treatment provided.
Currently there are an estimated 56,000 nurse practitioners working in the United States. Adding these medical professionals to the primary care task force will dramatically increase the number of medical professionals at the primary level of preventative medicine. More people will have access to primary care, and more people will be able to live happier, healthier lives.
Ashley Bender is a Public Citizen health policy fellow