Nurse practitioners in five states are demanding more responsibility and independence. Many physicians say their expanded role could risk patient safety, while others call that argument baseless.
Seventeen states and the District of Columbia allow NPs to set up practices and treat patients autonomously. Twelve states require supervision for NPs from a physician or health authority. And in the remaining 21 states, NPs must have a "collaborative" agreement with a physician, according to the Wall Street Journal. These might range from specifying which tests an NP can order to what percentage of a patient's chart a physician might review.
A California bill allowing NPs to practice autonomously passed the state Senate in May. Legislation that would grant NPs full practice authority is also pending in Pennsylvania, Michigan and Massachusetts. A New Jersey bill would give NPs autonomy after two years of collaboration with a physician or other advanced-practice nurses, according to the WSJ report.
More autonomous NPs have been seen as a solution by many healthcare experts to the nation's growing physician shortage. The United States could be down 65,800 primary care physicians by 2025, and some major institutions like the Institute of Medicine have encouraged states to loosen restrictions on NP practices.
Many physicians remain wary, however, arguing that autonomous NPs could hurt quality and patient safety. Some argue that an NP's training and education (five to seven years, on average) does not compare to those of physicians (11 years for most). The American Academy of Family Physicians has stated in a report that "substituting NPs for doctors cannot be the answer," according to the report. In May, a study found more than half of physicians believe physicians provide higher quality exams and consultations than nurse practitioners.
NP advocates, however, say it is time to stop perpetuating this idea. The WSJ report mentions states with greater supervision for NPs do not have better patient safety records, and that states with looser restrictions for NPs are likely to have more NPs in rural and underserved areas.
Ezra Klein and Evan Soltas wrote about the issue in a "Wonkbook" column for the Washington Post. The columnists said when physicians or states oppose more autonomy for NPs, they are actually encourging rising healthcare costs. They also point to the 17 states that have allowed NPs to practice autonomously, noting that "there's been no resultant rash of patient deaths" in those states.
"Doctors don't have a good answer for how they can rapidly expand to meet all this new demand. But they know they don't want nurse practitioners doing it," wrote Mr. Klein and Mr. Soltas. "Bringing down national healthcare costs will be hard. A lot of the calls will be wrenching, and the evidence on both sides will be close. Not this one."
More Articles on Nurse Practitioners:
Do PAs, NPs Impact Physician Satisfaction?
A Breakdown of Advanced Practitioner Autonomy in the United States
Survey: Physician Oversight Limits Patient Access to NP Care