The United States may spend more money on health care per year than any other country, but our results still leave much to be desired.
In fact, the US healthcare system often struggles to consistently ensure high quality care is delivered to patients. Making matters worse, we are on the verge of a shortage of primary care providers. Demand for these services, typically provided by physicians, is soon expected to outpace its supply, increasing costs and reducing access for patients. Rural and urban populations on Medicaid already face limited access to high quality health care. And while the US is certainly not as bad as Cuba, long wait times and high costs caused by these shortages cause patients to suffer. Especially when combined, these trends pose challenges for patient access, health care quality, and affordability.
As concerns about the weaknesses of our current health care system continue to grow louder in the public discourse, some have begun to support “Medicare for All” as a solution to ensure all Americans have access to health care. While this is a laudable goal that I share, the method of achieving it, “Medicare for All,” suffers from numerous shortcomings.
Instead, one reform that’s not only financially feasible but can also help ensure access while providing quality care is simply using a resource we already have more fully: Nurse Practitioners (NPs).
The number of NPs has been growing and will likely continue to grow. In fact, the total NP workforce is projected to nearly double from 2013 through 2025. This growth is essential as baby Boomers continue to age and increase demand for health care. If we used NPs to their full ability, we could meet patients’ health care needs while increasing access.
In some places, NPs are already being used by primary care practices to deliver care to patients. Unsurprisingly, there is growing evidence that NPs provide high quality care for their patients. In order to be able to practice, NPs are required to undergo extensive training, with most earning a Master’s degree. While they are highly trained, they do not face the same expensive educational requirements as physicians. This allows NPs to more easily afford to work in rural areas or for urban Medicaid patients. This dynamic allows NPs to increase access for the most underserved populations. Whether you support “Medicare for All” or a pure free market in health care, this is an outcome you should like.
Unfortunately, in much of the country NPs are not allowed to be a solution for the growing health care provider shortages. Currently, only 22 states (and the District of Columbia) allow NPs to use their full training and ability to serve patients. The remaining 28 states place restrictions on NPs in some way. 16 of them have reduced scope of practice laws that require NPs to have a collaborative relationship with a physician in order to practice. Meanwhile, 12 states have restrictive laws that force NPs to be supervised by or work alongside physicians. Despite being highly educated and capable health care providers, in many states they are simply not entrusted to perform the care they are trained to do. Although these laws are meant to protect patients, by reducing the availability of health care, they are actually harmful for patients struggling to find providers. It’s difficult to solve a health care provider shortage when NPs are legally tied to the physicians who are in short supply.
Despite these shortages, physicians and their professional organizations support continuing restrictions on NP’s scope of practice. They cite concerns about independent NPs overprescribing medicine and the increasing cost of medication. However, academic studies contradict those claims. Additionally, several other organizations, including the Federal Trade Commission, the National Governors’ Association, and the National Academy of Medicine, all support expanding the care that NPs can legally provide.
In a recent paper, Lusine Poghosyan, Edward Timmons, Cilgy Abraham, and Grant Martsolf found that by moving from a reduced to a full scope of practice for NPs, states reduced their outpatient costs by 17 percent and had 11 percent lower prescription drug costs. Additionally, the total care days for Medicaid beneficiaries rose by 8 percent. Not only can NPs increase access for one of the most underserved communities, they did so while reducing health care costs.
Recently, Washington State Senator Maureen Walsh came under fire for saying that nurses “probably play cards for a considerable amount of the day.” If she really is concerned about nurses having free time, the best solution would be to allow them to practice to their full training and ability. Expanding NP scope of practice has worked for those states that already allow this flexibility and evidence shows it will lead to better patient outcomes, more health care utilization, and done at a lower cost.
Catalyst articles by Conor Norris