EDITORIAL: Let nurse practitioners expand access

Citizens' Voice, The (Wilkes-Barre, PA)

April 17-- Apr. 17--Providing adequate access to medical care in rural and poor urban areas is one of the longest-running problems in U.S. health care, and Pennsylvania is a case in point. About 35 percent of state residents have limited access to primary care physicians.

One proposal to improve that access is to allow advanced practice nurse practitioners to practice independently of physicians.

Bills to allow it have passed the state Senate several times but have died in House committees. A new bill sponsored by state Sen. Camera Bartolotta, a Washington County Republican, should pass both houses.

Current state law restricts nurse practitioners only to working under collaborative agreements with physicians.

Bartolotta's bill would allow a nurse practitioner to practice independently after a three-year, 3,600-hour collaborative agreement with a supervising physician.

The Pennsylvania Medical Society, which represents 16,000 physicians and medical students, opposes the bill on grounds that nurse practitioners' education is not as extensive as that for doctors, and that allowing independent practices would diminish patient safety.

This is not an exotic idea, however. The National Academy of Medicine recommended full, rather than restricted practice for qualified nurse practitioners in 2011. Now, state lawmakers can be guided by the experience in 21 other states and the District of Columbia, which have established full practice for nurse practitioners.

Although the nature of medical practice is a major component of the controversy over expanding practice, the issue also crosses paths with politics and health care economics.

For all the recent warnings about "socialized medicine," this controversy illustrates a hazard of market-based health care access. Medical practices also are businesses, and the majority of them locate within high-population areas with demographic profiles that can sustain them. It makes no sense for the state to maintain restrictions on qualified practitioners who can fill the gaps in the market.

Bartolotta's bill does not limit nurse practitioners to only rural or poor urban areas. But the market will dictate where independent nurse practitioners take hold. And the new protocol would not preclude collaborative relationships or referrals.

Shortages of primary care physicians in rural and poor areas have persisted for decades, and unmet demand has only increased because of the aging population and greater access to health insurance through the Affordable Care Act. Lawmakers should embrace the opportunity to expand access using existing resources.

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