(*This piece has been updated to correctly reflect votes on scope of practice legislation)
By Mary Ellen Smith Glasgow
The United States faces a primary care provider shortage. As the population ages and people have health insurance under the Affordable Care Act (ACA), the Institute of Medicine cites significant increased demands on our health care system. An estimated 27 million Americans have gained health insurance coverage during the past five years due to the Affordable Care Act.
The American Association of Medical Colleges has estimated that the United States will be short up to 35,000 primary care physicians by 2025. Predominantly in rural and underserved areas, not enough physicians exist to meet the expected demand for health care for individuals living in those areas.
Despite these facts, the Pennsylvania General Assembly is standing in the way of a practical means to address needs and shortages.
Under current Pennsylvania state law, nurse practitioners cannot practice independently of physicians, thus contributing to a health care gap in rural and underserved areas. With a shortage of primary care physicians, nurse practitioners need to practice independently to expand health care access to underserved Pennsylvanians.
The American Academy of Nurse Practitioners (AANP) shows 87 percent of nurse practitioners are certified in an area of primary care and can care for patients in need.
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Legislation sponsored by state Sen. Camera Bartolotta, R-Washington (SB25) would allow Pennsylvania nurse practitioners to provide care without the oversight of a physician, after completing 3,600 hours with physician supervision over a three-year period.
The bill has passed the Senate three times.*
Nurse practitioners can address unmet health care needs and provide high quality accessible health care.
The American Association of Nurse Practitioners estimates 26,000 new nurse practitioners enter the health care market annually. Nurse practitioners are registered nurses who have advanced education (masters and/or doctoral level) and extensive clinical training.
Approximately 270,000 nurse practitioners are licensed in the United States. Nurse practitioners are educated to assess, diagnose and treat patients, and they hold prescriptive privileges in all 50 states and Washington, D.C.
Some studies have shown that the primary care outcomes—health status, physiologic measures, utilization, and cost effectiveness—are the same for nurse practitioners and physicians. Other studies show patients who use a nurse practitioner as their primary provider have fewer emergency room visits, shorter hospital stays, and a higher level of satisfaction with their care.
Depending on jurisdiction, nurse practitioners may or may not be required to practice under the supervision of a physician. In the United States, nurse practitioners have been lobbying for independent practice. Presently, twenty-one states and the District of Columbia, allow nurse practitioners to practice without physician supervision.
Even as schools of nursing graduate record numbers of primary care nurse practitioners and the need for their services becomes more critical, barriers prevent them from practicing to their full potential, even when solutions like SB25 are offered. A 2010 Institute of Medicine report concluded that such regulations have failed to keep pace with the evolution of advanced practice nursing over the past 40 years.
Critics of SB25 state the difference in education and training between physicians and nurse practitioners and allude to inferior care rendered by nurse practitioners as reasons to deny nurse practitioners’ independent practice privileges. According to the AANP, more than forty years of research consistently supports the excellent outcomes and high quality of care provided by nurse practitioners.
The body of research contradicts the critics’ claims. Nurse practitioners are registered nurses with generally four years of education and clinical training at the baccalaureate level, followed by two to four years post-baccalaureate training. They hold national certifications. Many of these individuals also have years of clinical experience as registered nurses before pursuing their masters or doctoral degree. They are very well equipped to care for patients.
The original concept of the nurse practitioner was to increase access to health care, especially for uninsured populations and underserved rural areas.
Since the advent of the nurse practitioner, the need for primary care physicians has increased as the interest of medical students to pursue a primary care specialty has declined. A significant shortage in the delivery of primary care jeopardizes Pennsylvanians’ access to the most basic health care, including preventive services. Greater and full use of nurse practitioners could alleviate a significant portion of the primary care provider shortage.
Will nurse practitioners fill this critical vacancy of primary care providers and care for Pennsylvanians? No, not without the long-overdue passage of Bartolotta’s legislation.
Dr. Mary Ellen Smith Glasgow is Dean of the School of Nursing at Duquesne University. A past Trustee of the Princeton HealthCare System and a 2009 Robert Wood Johnson Foundation Executive Nurse Fellow, she is also the co-author of three books, two of which have won the American Journal of Nursing Book-of-the-Year Award.