by Mike Miesen –
In the last two weeks, our two most populous states, California and Texas, have begun the process of significantly expanding the scope of practice for non-physician providers. Though you’ve probably been reading about that other news coming out of California, this is arguably more important, and will undoubtedly affect the way you use the health care system—but you may not even notice a difference.
Two weeks ago, the Texas House approved Senate Bill 406, which would
eliminate the requirement for on-site physician supervision to allow doctors to delegate the authority to prescribe and order medical devices to advanced practitioner nurses and physician assistants. It will increase the number of advanced practice nurses a physician can supervise from four to seven…It will also allow physicians to delegate authority to advanced practice nurses and physician assistants to prescribe Schedule II controlled substances, which are classified as having a higher potential for abuse, in hospitals and hospice settings.
In other words, it allows nurse practitioners to “practice at the top of their training,” as state Senator Jane Nelson put it.
Out west, California’s Senate approved a law that would “allow nurse practitioners to have stand-alone practices to prove primary health care services independent of physicians, including certification of disability claims, prescription drugs, and approving many treatments.”
Partially, these laws are a reaction to the projected doctor shortage, which, according to some estimates, could be as high as 130,600 physicians (65,800 or which are primary care physicians) by 2025. Potential cuts to Indirect Medical Education in President Obama’s 2014 budget (which won’t pass, but I looked at the details and background here) could make the shortage much larger in the coming years.
We’ve covered this before. I’m skeptical about the looming shortage for a number of reasons—one of which is precisely what we’re seeing: states are noticing that it’s the rent-seeking regulations that are preventing advanced practitioners from appropriately caring for patients “at the top of their training,” not the top of their training itself. Advanced practitioners will reduce the number of physicians we’re short.
While California and Texas are late to the game—play with ths interactive graph to compare them with other states—the sheer size of these states will make the heath care community notice. If enacted, these bills would change how health care is delivered for tens of millions of people, and could help nudge the other ten “restricted practice” states (see below) towards their own similar expansions.
We can expect the loosening of regulations to lead to cheaper, more efficient care in the long term; a nurse practitioner’s hourly rate is lower than a physician’s and, assuming they can both conduct a high-quality, basic check-up—and evidence suggests that quality and patient satisfaction is higher along some metrics nurse practitioners compared to physicians—everyone is better off. It’ll also mean shorter wait times, as the supply of available clinicians will rise.
Significantly, both of these factors could lead to clinicians accepting Medicaid patients at a higher rate than before. Worrying research has shown that, increasingly, physicians have been unwilling to take on new Medicaid patients due to the low reimbursement rate relative to Medicare or private insurance. Relaxing scope-of-practice regulations will mean that these patients may soon be able to more easily receive the care they need.
But back to you, average consumer of health care: how might these changes affect you (assuming you live in California or Texas, of course). Rather than see a physician for a simple physical or check-up, in the coming months you may be able to see a nurse practitioner or other advanced care provider. He or she will be able to administer injections and prescribe medications.
Honestly, you may not even notice a difference—unless you notice the cheaper care and shorter wait times. Which is really all the evidence you need to support Texas and California’s legislation to expand the scope of practice for advanced practitioners.