To Address Doctor Shortage, Nurse Practitioners Bill is a Must-Pass

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This bill allowing state certified (think about that) nurse practitioners to practice without a doctor’s oversight has been introduced by a few Republican legislators, but every single Democrat should be on bill 1063, especially those claiming to be progressives.

Here’s a longer policy brief on this issue for our state legislative staffer friends, but the basic shape of the issue is that Pennsylvania currently forces certified nurse practitioners – people who have already completed a state certification process to do this job – to bill their primary care services through doctors’ practices, rather than independently.

So every time they provide primary care service to a patient, regardless of whether a doctor even saw that patient, they have to kick a cut of the money they earned upstairs to the MD.

This needlessly increases health care prices, and it’s purely a rent-seeking scheme cooked up by the physician lobby.

That’d be bad on its own, but at a time when we’re hearing about a “doctor shortage” in this state (mainly a primary care issue), it just doesn’t make sense to keep restricting state certified nurse practitioners from opening their own practices to provide basic primary care to the increased number of people who now have health insurance through the Affordable Care Act.

Across the United States, “scope of practice” laws vary wildly from state to state, so they don’t really have a basis in any kind of legitimate policy considerations. Rather, they’re a reflection of the relative political power of physician lobbies like the Pennsylvania Medical Society vs. nurse practitioner groups.

This isn’t anybody’s favorite election year issue, but it matters a great deal, and if you read this far then you should ask your local state House and Senate candidates to commit to the anti-shortage position when you next see them out campaigning.

This entry was posted in Economy, Elections, Governor, Health, State House, State Senate.

12 Responses to To Address Doctor Shortage, Nurse Practitioners Bill is a Must-Pass

  1. Health Care Expert says:

    Very doubtful that nurse practitioners will be able to address the doctor shortage by eliminating the collaborative agreement they have with physicians. NPs are already seeing patients. It’s not like suddenly they’ll be able to see more patients. Sorry but this is a myth in this political debate and it isn’t logical. If you want to solve any shortage of any profession then build up the profession. If there is a doctor shortage, then produce more doctors. It’s that easy.

    • Jon Geeting says:

      The issue is that they’ll be able to form their own practices, people will be able to get health care for cheaper which will grow demand, and then more people will want to become NPs. We can produce more new NPs quickly than new doctors.

      • Sparta of Phoenix AZ USA says:

        Why do you think that no bill has been proposed to allow ECFMG certified PHYSICIANS to practice first? Do you think the AMA and AAMC lobby might have something to do with that? Did you know there are thousands of them, many US CITIZENS, trained on the AMERICAN TAXPAYER dime…

        Who wins here? Oh yes, for sure NP’s but also the many new schools that will pop up backed by Uncle Sam, aka tax payer (no racket in higher education, nah nothing to see here folks). The AMA and AAMC will keep their beloved “rank” and “prestige” etc…This whole thing stinks! Has nothing to do with patients…

        Also, are they under the assumption that just because you make more NP’s they are going to run to Primary Care? They all mostly practice in the specialties as it is now…They will follow the money just like Doctors. Of course, the hospitals can higher them on the cheap in comparison to a doctor…Nothing to see here…

        • Jon Geeting says:

          Obviously this is not the only change we need to make to the scope of practice or payment policies in America or Pennsylvania. But it’s a step in the right direction.

        • Theresa Dippolito CCM, MSN, NP-C, CRNP, APN says:

          I beg to differ. I am an NP and most NPs I know do not practice in specialties, they practice in primary care in Family Practice, Internal Med, Peds, and Women’s Health which also provides pirmary care. I practice in Primary Care in an Internal Med office because that is the “specialty” I prefer.
          Primary care NPs provide urgent care medical services for patients of all ages in walk in clinics or fast track areas in ED depts.
          NPs also do practice in hospitals performing services that residents used to perform but are prevented from doing because of regulations limiting Resident hours.
          Some NPs prefer specialty practice, but less so than the numbers practicing in Primary Care.
          Eliminating Collaborative Agreements (at the very least for NPs who have practiced for 2 years), and outdated Medicare or State requirements that mandate services be provided only by physicians, or be reviewed by physicians, will decrease costs and allow more access to quality care for patient consumers. NP care is quality care that is less costly for everyone. Hence, one reason so many physician practices are now hiring more NPs as opposed to only hiring MDs.

    • L Kanders says:

      Why do we need to produce more docs when NPs can fulfill this role. Why not beef up all.

  2. JoyfulA says:

    Maybe 15 years ago, I edited a book for nurse practitioners about prescribing drugs. I initially thought it was crazy because nurses can’t prescribe, so why publish a book on prescription strategies for them? That was when I learned that only in Pennsylvania could nurse practitioners (who mostly held doctorates) not prescribe.

    Can nurse practitioners now prescribe in Pennsylvania?

    • Lorraine Bock says:

      Yes, but only if we sign a collaborative agreement with 2 physicians.

    • LMorrison CRNP, DNP says:

      Nurse practitioners can now prescribe in Pennsylvania but they must demonstrate continuing education credits to renew biannually the prescriptive authority licensure.

    • Theresa Dippolito CCM, MSN, NP-C, CRNP, APN says:

      Yes. Full prescribing including scheduled narcotics under their own license, not the Dr license. I hold my own DEA number

  3. Natalie says:

    No, it really will improve access. Right now if you are a NP who wants to practice in an under served area and can’t find a supervising physician, you have to practice elsewhere or accept a job working as a registered nurse rather than utilize your NP training. I am a nurse practitioner student at Vanderbilt University, and here in Tennessee (which requires a supervising physician), I know a significant number of certified nurse practitioners who either can’t practice where they want to practice or have had to go back to working as an RN due to lack of supervising physicians.