Floridians make countless visits to the state’s 18,000 nurse practitioners every year. These professionals have graduate degrees and advanced clinical training. But only about half of states allow them to diagnose and treat patients independently, even though they’re well-qualified to do so.
Physician assistants, likewise, typically have master’s degrees and thousands of clinical hours under their belts. Yet state laws — like the ones here in Florida — bar them, too, from practicing to the full extent of their abilities.
These “scope-of-practice” laws are outdated, costly and harmful to Americans’ health.
Amid the COVID-19 pandemic, the federal government has cut red tape and enabled hospitals to use nurse practitioners to a greater degree, given the heightened strain on doctors and other staff. Several states also suspended or waived certain scope-of-practice requirements for physician assistants.
It shouldn’t have taken a pandemic for us to recognize their value or their ability. And unfortunately, most of the rule changes are temporary.
Nurse practitioners and physician assistants will be indispensable to our healthcare system long after the pandemic passes. More than 6.6 million Floridians have insufficient access to primary care physicians. That figure is projected to grow as Florida’s population ages, leading to increased demand for care. Already, nearly 40% of the state’s doctors are near retirement age.
All told, the state will be short more than 3,000 primary care doctors by 2025.
The nurse practitioner and physician assistant workforces are growing more rapidly than the supply of physicians, a trend expected to continue through 2030, according to a study published in Health Affairs.
Yet even though many of these professionals are fully qualified to provide primary care — to serve as patients’ first point of contact within the healthcare system — they are still not authorized to do so across wide swathes of the country.
In Alabama and Georgia, for example, nurse practitioners cannot prescribe medications without direct authorization from a supervising physician. And in spite of their skillsets, neither state formally recognizes these clinicians as primary care providers.
Until recently, Florida’s nurse practitioners faced similar barriers. But thanks to legislation passed in March 2020, they can now provide care independently, upon completion of certain requirements.
Similarly, strict state-based restrictions exist for physician assistants. Florida still does not allow any unsupervised practice. But in states like Michigan, for instance, they may work with more autonomy.
Scope-of-practice laws have endured in part because of lobbying from special interest groups that represent doctors. By convincing state legislators to bar nurse practitioners and physician assistants from competing with primary care doctors, these groups can protect the financial interests of their members — at the expense of patients.
The doctor lobby claims that scope-of-practice laws protect patients and improve the quality of care they receive. But those arguments don’t hold up under scrutiny.
One study published in October 2020 by the journal Nursing Forum found that nurse practitioners provide equivalent or even higher-quality care than physicians, and see greater patient satisfaction. They’re also more cost-effective. Another study published in the journal Health Services Research concluded that they deliver care for 29% less than primary-care physicians.
Likewise, patients report little difference in satisfaction levels between physician assistants and physicians.
If there were legitimate safety concerns about nurse practitioners and physician assistants, we would likely see different health outcomes in states where they have permission to provide independent care as compared to states where they don’t. But there is no statistically significant difference in the quality of care across those states.
Public health leaders and lawmakers are starting to see the light. The National Academy of Medicine recently reported that eliminating restrictions on nurse-practitioner scope of practice will improve both access to care and health equity.
In June, Governor DeSantis signed a bill into law that allows physician assistants to receive direct payments for their services and increases the number of physician assistants a doctor can oversee at one time. But these healthcare workers still can’t practice on their own.
Our health needs are going to grow in the years to come. It’s time to put patients first, and let talented, trained professionals like nurse practitioners and physician assistants do their jobs unencumbered.