The California legislature sent a bill to Gavin Newsom’s desk last week that would grant nurse practitioners the ability to practice without doctor supervision, albeit with some concessions to the doctor’s lobby in the state.
Currently, nurse practitioners can practice and see patients in California only if they have a written agreement with an overseeing physician, in return for a fee, one of a dwindling number of states with restrictive scope of practice laws. As of now, California is the only Western state to require them to practice under physician oversight.
The bill, AB-890, does make concessions to the doctor’s lobby, with requirements that did not exist on prior bills in 2013 and 2015, such as additional certification, state-specific testing, physician supervision for a number of years, and disclosure to patients that they are not doctors.
Care and Nurse Practitioner Scope of Practice Laws
Nurse Practitioners, or NPs, are registered nurses with additional education and training so they can deliver a greater degree of care than RNs, such as diagnosis and treatment of acute and chronic illnesses and issuing prescriptions.
The California Health Care Foundation report above outlines the effects on California residents of it’s restrictive scope of practice laws.
Research has linked such restrictions to key healthcare measurements, namely:
- Lower supply of NPs
- Lower use of primary care services
- Greater rates of hospitalization and emergency department visits
- Poorer access to care for CA residents
Studies support the position that the quality of NP care is comparable to the quality of physician care, yet the physicians lobby in California has successfully lobbied against prior bills that would expand NPs scope of practice.
California Scope of Practice is Behind Other States
California is a restricted practice state, one of the last few states to grant nurse practitioners some level of independence, according to the American Association of Nurse Practitioners. California’s bill would still keep the state behind the 22 states that have granted full independence of practice to NPs.
All this despite the clear need for more primary care and prevention work among the population. It’s estimated that by 2030, physician supply in California will meet less than half the demand for primary care. Accredited and trained nurse practitioners could help bridge this gap by delivering quality primary care at a lower overall cost of care.
This is exacerbated by the trend among physician trainees to drift towards specializations that typically treat existing conditions, such as oncology, surgery, and dermatologists, and away from general practitioners, internists, and pediatrics, for the income potential.
Nurse Practitioners Can Supplement General Practitioner Physicians
According to a survey conducted by Medscape, 90% of resident respondents said future earnings have an influence on their specialty choice. One of the study authors, noted the effect of undergraduate and medical school debt on trainees selecting a specialty, “There is an egregious discrepancy in income between specialties that reflects a healthcare system profit model that rewards procedural intervention more than it does prevention” (emphasis mine).
This shouldn’t be surprising, given that the same survey found that 50% of residents have over $200,000 in medical school debt, and a whopping 24% reported debt over $300.000.
Given the lowered barriers to change caused by COVID, we may yet see this bill or one like it signed into California law in the near future. This is especially promising since Newsom signed an order in March that temporarily relaxed physician oversight of NPs.
So will California catch up to other states in permanently granting nurse practitioners full or at least greater scope of practice? That remains to be seen.
“California’s Nurse Practitioners: How Scope of Practice Laws Impact Care.” Joanne Spetz, Healthforce Center at UCSF. May 2 2019.
“State Practice Environment.” American Association of Nurse Practitioners.