California’s scope of practice bill was shot down last night. Here’s why that matters.

by Mike Miesen

An effort to increase the scope of practice for Nurse Practitioners in California was voted down 6-3 yesterday by the California Assembly.

Senate Bill 491 originally would have explicitly allowed NPs to practice certain procedures without oversight from a physician (emphasis added):

This bill would revise these provisions by deleting the requirement that those acts be performed pursuant to a standardized procedure or in consultation with a physician and surgeon. The bill would also authorize a nurse practitioner to perform specified additional acts, including, among others, establishing physical diagnoses and prescribing drugs and devices.

It was watered down during its short life, and the explicit authority was diluted to vague “additional acts”:

Existing law authorizes the implementation of standardized procedures that authorize a nurse practitioner to perform certain acts, including, among others, ordering durable medical equipment, and, in consultation with a physician and surgeon, approving, signing, modifying, or adding to a plan of treatment or plan for an individual receiving home health services or personal care services… This bill would authorize a nurse practitioner to perform those acts and certain additional acts without physician supervision if the nurse practitioner meets specified experience and certification requirements.

The bill’s early death was ferried through by the California Medical Association, an interest group representing physicians. Its president, Paul Phinney, argued that the bill would fracture coordination of care: “What the bill would do is break down the cooperation, the tight cooperation between physicians and nurse practitioners.”

Put a different way, though, that’s the point.

What Dr. Phinney refers to as “tight cooperation” is a requirement that NPs have a physician looking over their shoulders to OK the plan of care for their patients.


As we’ve discussed before, it’s not clear that this oversight is beneficial to – or even preferred by – patients. Research has shown that, in some circumstances, quality and patient satisfaction are higher when a NP cares for a patient compared to a physician, and when time is a factor, patients sometimes even prefer being seen by a NP.

California is behind the curve on efforts to allow NPs and physician assistants to “practice at the top of their training.” The majority of states have far fewer restrictions on what the advanced clinicians are able to do. The bill’s author said he’s hoping it will be reconsidered in the future.


Mike is a healthcare consultant turned aid worker turned traveler (currently: East Africa) and freelance journalist. Follow him on Twitter @MikeMiesen or subscribe to the blog.


One thought on “California’s scope of practice bill was shot down last night. Here’s why that matters.

  1. Carolyn Harris-Muchell says:

    This decision is very disappointing. It is not in the best interest of the thousands of insured and uninsured Californians who do not receive care because physicians have capped the number of MediCal and Medicare patients that will see. The number of new physicians entering primary care is minimal while the number of advanced practice NPs entering primary care increases. Once again the paternalistic attitude of physicians is political and places there concerns about patient care. The bill have to be reintroduced and receive stronger community and nursing school involvement. Dr. Harris-Muchell

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