Nearly 84 million Americans live in “primary-care health professional shortage areas” — places that don’t have enough primary-care physicians to meet patient need. That includes over 7.8 million patients living here in California.
Even in the face of this shortage, only 25 states grant the right of “full practice” to nurse practitioners, or NPs, who could immediately address this problem.
In the remaining states, “scope-of-practice” laws prevent NPs from evaluating patients, ordering and interpreting diagnostic tests and managing treatments. States with such curbs include progressive California, retired-haven Florida and ostensibly liberty-loving Texas.
States can end this unpardonable waste of human resources — and expand patient access to primary care — by repealing these antiquated laws.
It’s no surprise that some of the states that restrict NPs’ scope of practice are short on primary care. In Texas, for example, 228 of the state’s 254 counties are primary-care health professional shortage areas.
The country’s primary-care shortage is only poised to get worse. The Association of American Medical Colleges projects that we’ll be short 48,000 primary-care physicians by 2034.
Repealing scope-of-practice laws could reduce the number of Americans living in counties with primary-care provider shortages by 70%.
Doctors’ groups such as the American Medical Association have opposed any significant easing of scope-of-practice restrictions for health professionals such as nurse practitioners and physician assistants.
Their opposition is understandable from a purely economic perspective. It’s natural that a professional group would seek to bar potential competitors in order to protect its members’ compensation.
But that doesn’t make it right. Patients ultimately pay the price for these government-enforced limits on the supply of care, in the form of longer waits to see a doctor, rationed care and higher prices.
Defenders of scope-of-practice rules say that they’re protecting patients from health care providers who are less skilled than doctors — and thus necessarily provide lower-quality care.
But research doesn’t bear that out. Studies have shown no difference in outcomes between patients treated by nurse practitioners or physician assistants and by doctors. A 2018 study found that patients with diabetes who received primary care from nurse practitioners were less likely to be admitted to a hospital than those with physician primary-care providers.
A January report from the National Bureau of Economic Research concluded that expanding the scope of practice of nurse practitioners does not harm quality of care. It does, however, have the potential to lower health care costs, as a paper published earlier this year in Health Economics concluded.
Still, efforts to block scope-of-practice reform bills have been successful in many states. In 2021, bills that aimed to relax restrictions on nurse practitioners and other health care professionals were defeated in Florida, Kansas, Kentucky, Louisiana, Maine, Mississippi, Tennessee and Texas.
Nevertheless, some states are making progress. Arkansas lawmakers have voted to recognize NPs as primary-care providers. In New York, Gov. Kathy Hochul included a measure to ease physician oversight of nurse practitioners in her budget proposal this year.
More states should follow follows. With demand for primary-care providers expected to rise by 20% in the next decade, the gap between supply and demand will only grow wider. Nurse practitioners have the skills to fill that gap quickly and affordably.
Sally C. Pipes is president, CEO and a health care policy fellow at the Pacific Research Institute.