New York governor Kathy Hochul signed a new budget this month that contains a welcome provision: granting “full practice authority” to licensed nurse practitioners (NPs). Going forward, the Empire State’s 14,300 NPs will have authority to diagnose patients, order tests, and prescribe medications without physician supervision.
For too long, outdated and ineffective policies have constrained NPs and other qualified medical professionals. Repealing these laws will make it easier for patients to gain access to affordable, quality care. With a national physician shortage on the horizon, other states would be wise to follow New York’s lead.
NPs are registered nurses who hold a master’s or doctoral degree and have completed “advanced clinical training” in their field. Broadly speaking, NPs function like primary-care doctors. They can order x-rays, diagnose conditions, and oversee courses of treatment. But onerous licensure requirements prevent many of the nation’s 355,000 working NPs from carrying out many of these duties.
In the 1970s, states began passing laws to regulate NPs and physician assistants. These “scope-of-practice” laws were intended to protect patients from malpractice by subordinating NPs and PAs to physicians, who attend medical school. As long as there’s a doctor in the room, the thinking went, not much can go wrong. As a result, NPs in the 25 states that still have scope-of-practice laws on the books can’t diagnose or treat patients without physician supervision or sign-off.
These policies would make sense were it not for the evidence that NPs are capable of practicing on their own. Research shows that NPs perform just as well as physicians in specialty settings, and they consistently fare well with patients, too.
Scope-of-practice laws are especially inopportune today. The United States is projected to be short of up to 124,000 physicians by 2034, according to the Association of American Medical Colleges. Granting full practice authority to NPs would help soften the blow, particularly for the 90 million Americans living in areas with a shortage of primary care providers. The number of Americans living in a county with a primary-care shortage would drop 70 percent if every state granted full practice authority to NPs and PAs, one study found.
Even under the current regulatory regime, NPs are on the frontlines of America’s doctor shortage. Compared with primary-care doctors, NPs are more likely to practice in rural areas and in federally designated “Health Professional Shortage Areas.” New York’s NPs are mostly concentrated upstate and in rural areas, and nearly half work in clinics. But the benefits of unleashing NPs would extend beyond these underserved regions. Granting full-practice authority to NPs nationwide would save the U.S. health-care system an estimated $810 million per year at retail clinics alone.
Repealing scope-of-practice laws would also mark an important step forward in American health-care reform. Too often, policymakers try to improve the health-care system by imposing regulations that create more problems than they solve. A commonsense solution is often better than a wonky regulation.
Several states—including New York—seemed to realize this when they temporarily waived scope-of-practice laws on NPs and PAs during the pandemic. New Yorkers are lucky that Hochul has now made this change permanent; more governors should follow her lead.
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