It’s Time To Take Aim At Scope-Of-Practice Laws

In the last three months, state legislators have introduced more than 70 bills that would modify “scope-of-practice” laws—regulations that set limits on the care physician assistants, nurse practitioners, and other qualified professionals can provide to patients.

It’s no wonder why. Many state lawmakers understood the benefits of temporarily relaxing these restrictions as COVID-19 strained the healthcare system. Freeing up physician assistants and nurse practitioners to provide more services made it easier for patients to access care during the pandemic. And it gave physicians more time to treat patients with more serious medical issues.

The same will be true after the public health crisis ends. Permanently rolling back restrictive scope-of-practice laws—and letting experienced healthcare workers do their jobs—is a common-sense reform that could benefit patients and the healthcare system alike.

Physician assistants and nurse practitioners hold graduate-level degrees and have hundreds of hours of clinical experience. Yet some states’ scope-of-practice laws bar these professionals from prescribing certain medications or practicing without doctor supervision.

That’s nonsensical. Physician assistants and nurse practitioners deliver high-quality care.

Consider a recent review of more than 30 studies, which found that physician assistants provide the same or better level of treatment than doctors. Under a physician assistant’s care, patients experience fewer complications, reductions in hospitalizations and readmissions, and boosts in quality of life.

A new University of Pennsylvania study came to a similar conclusion about nurse practitioners. Researchers found that hospitals employing more nurse practitioners report 20% fewer deaths after common surgeries than hospitals with smaller numbers of NPs.

Allowing more of them to provide a wider array of primary care could also alleviate the U.S. doctor shortage. The Association of American Medical Colleges predicts the country could face a shortfall of up to 48,000 primary care physicians by 2034.

Physician assistants and nurse practitioners are well-suited to plug this gap—and enable the 83 million Americans living in areas with an inadequate supply of primary care to access the services they need. In fact, allowing nurse practitioners alone to practice primary care to the full extent of their training could reduce the number of U.S. residents living in areas with shortages by 70%.

Nevertheless, efforts to maintain the status quo on scope-of-practice regulations abound. One of the latest examples is an analysis of data from the Hattiesburg Clinic, an accountable care organization in the southern part of Mississippi.

Researchers found that patients receiving primary care from nurse practitioners, physician assistants, and other “advanced practice providers” spent $43 more monthly than those treated by a doctor. As a result, they concluded, “Nurse practitioners and physician assistants should not function independently.”

Other studies have found just the opposite. Research in Health Affairs, for instance, concluded that patients with medically complex conditions spent up to $2,300 less annually when treated by a physician assistant or nurse practitioner instead of a doctor.

Utilizing these healthcare workers could yield significant savings for individual states as well. Researchers at Duke University found that Pennsylvania could improve primary care quality and save $6.4 billion over 10 years by allowing nurse practitioners to treat patients to the full extent of their training.

Unsurprisingly, the authors of the Mississippi study also admitted that if it weren’t for the “addition of over 100 nurse practitioners and physician assistants to the Hattiesburg Clinic over the past 15 years, our organization could not have provided services to thousands of patients who might have otherwise gone without care.”

Thousands might be a low estimate. More than 1.7 million residents live in primary care shortage areas in Mississippi.

Many of those patients would be glad to hear there’s a simple way to ease that shortage—and provide them with high-quality care at a lower cost. Relaxing scope-of-practice laws could do just that.