Opinion: In the physician shortage, there’s a solution patients agree with — but the laws don’t
With long waits and lack of availibility altogether, patients are having a difficult time accessing health care during this doctor shortage. Revisiting scope-of-practice laws could help
The quickest way to get less of something is to regulate it. Nowhere is that more apparent than in the health sector, which suffers from a chronic shortage of physicians, particularly in primary care.
And it’s about to get worse. According to the Association of American Medical Colleges, the United States is facing a shortfall of up to 48,000 primary care physicians by 2034, especially in rural and historically marginalized urban areas.
Many states are turning a blind eye to this looming shortage — 24 still have on their books restrictive “scope-of-practice” regulations that prevent nurse practitioners from treating patients independently, without the oversight of a physician. The rules governing physician assistants tend to be even stricter.
These laws needlessly restrain the supply of health care — and thereby force patients to pay higher prices and endure longer waits. Removing or at the very least relaxing them, by contrast, would improve patient access to primary care — and reduce overall health costs in the process.
It’s intuitive that more providers competing for patients’ business would lead to lower prices. And indeed, a 2016 study published by George Mason University’s Mercatus Center found that when physician assistants have broad autonomy, the cost of outpatient care is as much as 14.4% lower.
Interest groups that oppose scope-of-practice expansion — like the American Medical Association, the country’s largest lobby group for doctors — assert that it threatens patient safety. But research doesn’t support that argument.
For example, a 2018 study by doctors at the College of Health and Public Affairs at the University of Central Florida concluded that “there are strong indications that the quality of patient outcomes is not reduced when the scope of practice is expanded.”
Another study out of Brandeis and Boston College tracked cancer tests, chronic disease outcomes, and overall patient well-being. That study, published in 2017, found that scope of practice regulations “do not improve the quality of care.”
In fact, expanding scope of practice for nurse practitioners and physician assistants is in doctors’ interests. More than 6 in 10 physicians say they’re experiencing feelings of burnout.
Allowing nurse practitioners and physician assistants more freedom to diagnose, treat and follow up with patients — especially those with basic health concerns — would free overworked doctors to handle more complicated cases.
Patients want to see scope-of-practice rules fade away. More than 8 in 10 support allowing nurse practitioners to provide the full extent of care, including through telehealth, according to polling from Morning Consult.
Restrictive scope-of-practice rules are unwarranted government intrusions in the healthcare market. They inflate prices, reduce people’s choices and make it harder to access care. Scrapping them will be crucial to addressing our country’s long-term primary care shortage.
Sally C. Pipes is president, CEO and Thomas W. Smith fellow in health care policy at the Pacific Research Institute. Her latest book is “False Premise, False Promise: The Disastrous Reality of Medicare for All.” Follow her on Twitter @sallypipes.