In August, Delaware Governor John Carney signed legislation that grant’s the state’s nurse practitioners full practice authority (FPA). In doing so, Delaware became the 24th state (in addition to the District of Columbia and two U.S. territories) to adopt FPA legislation — and not a moment too soon.
The physician shortage is real and growing and NPs can help fill the gap. An analysis conducted in June 2019 by the American Association of Medical Colleges (AAMC) confirmed this fact with metrics that projected a shortfall of up to 139,000 physicians by the year 2033.
A good percentage of the predicted and worsening physician shortage lies in primary care – with AAMC’s data suggesting it could reach just over 55,000. In specialties, the numbers are even higher – with a predicted potential shortfall of specialty physicians of nearly 87,000.
A solution to the physician shortage is direct access to nurse practitioner-provided health care, said Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP, Immediate Past-President of the American Association of Nurse Practitioners (AANP).
“One of the most important challenges facing patients and states is the accessibility of healthcare providers — especially providers who serve in primary care and across the continuum of care,” she said.
Full Practice Authority Supported by Evidence
“In states with FPA, NPs are authorized to evaluate patients, diagnose, order, and interpret diagnostic tests and initiate and manage treatments — including prescribing medications — under the exclusive licensure authority of the state board of nursing,” said Thomas.
This licensure model is supported by decades of evidence and recommended by the National Council of State Boards of Nursing, the National Academy of Medicine (formerly the IOM), and other leading health policy experts, she said.
Not all states have authorized FPA for their NPs. Many states maintain barriers to NP-delivered health care, she said.
“Unfortunately, in the remaining states, outdated licensure laws impede access to care and contribute to increased healthcare costs,” Thomas said. “The AANP is committed to working with states to update their licensure laws and provide patients with direct access to NPs.”
Out of the remaining states that maintain restrictions on NP practice, a dozen of them have introduced legislation for FPA this year, said Thomas.
“Several others have introduced bills to address other challenges, like the recognition of NP signatures on forms related to patient care,” she said. “Given the intense focus on healthcare delivery and health equity this year, legislators are looking closely at how modernizing licensure laws can improve care in their states.”
April N. Kapu, DNP, APRN, ACNP- BC, FAANP, FCCM, FAAN, President of the AANP, also voiced support for states that continue to seek FPA.
“States with FPA demonstrate a proven track record for increasing accessibility and patient satisfaction, while maintaining excellent care quality and outcomes,” Kapu said in a release. “We are encouraged to see other states looking to modernize their laws, eliminate healthcare disparities, and increase healthcare access and choice for patients by fully engaging the NP workforce.”
Addressing Physician Shortage via NP Legislation
To provide more complete care to seniors, the AANP supported the passage of the CARES Act in March of 2020, which bolstered seniors’ access to home healthcare services, said Thomas.
“The law authorized NPs to certify and recertify home health care services for Medicare patients, strengthened funding for personal protective equipment (PPE) for nurse practitioners (NPs) and other healthcare providers, and ensured vital resources to respond to the pandemic,” she said.
In California, a state assembly bill AB-890 passed in August 2020 that removes practice restrictions for the majority of California NPs, said Patricia Anaya Gurney, MSN, RN, PPCNP-BC, President of the California Association for Nurse Practitioners (CANP) and a practicing PNP in a large primary care pediatric practice for Sutter Medical Group in Roseville, California.
“AB 890 creates two categories of NPs: 103 and 104 NPs (named after the sections of the code where delineated [2837.103 and 2837.104] who may practice without standardized procedures.”
The 103 NPs work in specified healthcare settings including, but not limited to, clinics, home health agencies, medical groups, and hospice, she said.
“Under one section of this new law, 2837,104(a), 104 NPs will be able to function independently under a nursing or nurse practitioner corporation as of January 1, 2023,” she said.
Gurney noted that COVID-19 played a significant role in the legislation getting passed. “Lawmakers who had previously opposed the bill, saw the need for greater access to care due to the pandemic,” she said.
California is also experiencing a physician shortage, but NPs can help bridge the gap, said Cynthia Jovanov, DNP, MBA, ACNP -BC, FNP -BC, CNS, CCRN, RNFA, a practicing NP in the General Surgery Service Line at Eisenhower Medical Center in Rancho Mirage, California, and President-Elect for the CANP.
“Patients need us, and we’re here to help and serve,” she said. “In both primary and specialty care, expansion of NP practice also expands teams and increases access to care for patients.”
Beth Haney, DNP, FNP-C, FAANP, Health Policy Conference Chair of the AANP, former mayor and current councilwoman of Yorba Linda, California, and CEO of Luxe Aesthetic Center Inc., said that once the law in California takes effect and regulations are in place, patients will have more access to care. This will come as many NPs will likely choose to work in underserved areas, as well as densely populated regions.
“The new law, AB-890, will also make it easier for NPs with an entrepreneurial spirit to open their own practice,” she said. “NPs could obtain a business license and run their practice in ways that best serve their patient population.”
In addition, pending legislation is seeking to help reduce restrictions on NP practice.
One example of federal barrier reduction legislation is the Increasing Access to Quality Cardiac Rehabilitation Care Act of 2021, H.R.1956, which was introduced in the House and was previously passed as part of the Bipartisan Balanced Budget Act (BBA) of 2018 (Public Law 115–123), said Thomas.
“The bill would authorize NPs and PAs to supervise cardiac and pulmonary rehabilitation, starting in 2024,” she said. “This legislation would change the BBA’s effective date for supervision of these services from 2024 to 2022, and authorize NPs and PAs to order cardiac and pulmonary rehabilitation starting in 2022.”
NPs as Primary Care Providers
Currently, patients have difficulty in locating NPs as primary care providers because in general, only physicians are listed in directories, said Haney.
“I hope more NPs open their own primary care practices when the law in California is implemented,” she said. “This will help ease the healthcare burden because patients will have more visible choices of providers at more locations.”
A solid body of evidence demonstrates that NPs have consistently proven to be cost-effective providers of high-quality care for almost 50-years, said Thomas.
“The COVID-19 pandemic has laid bare the critical need to strengthen patient access to care, reduce health disparities and combat the rising incidence of chronic disease,” she said. “NPs offer 290,000 solutions to strengthening health care for our nation. It is time to grant NPs full practice authority — and to ensure every patient direct access to the healthcare provider of their choice.”
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