Nevada Gov. Brian Sandoval (R) has signed a bill that would allow most nurse practitioners and physician assistants in the state to prescribe medications without having to first get permission from a doctor. The new law is expected to help poor and rural Americans gain access to more comprehensive health care services and will help make Obamacare implementation smoother.
Nurse practitioners are advanced practice registered nurses. These types of nurses must go through a higher level of training than ordinary registered nurses and may provide certain diagnoses and treatment recommendations to patients for a host of primary and acute medical problems.
There are 33 other states that still require nurse practitioners to receive written consent from a physician before prescribing common drugs such as painkillers, blood pressure medication, and other medicines.
That can mean less access to essential prescription drugs for poor patients and Americans living in rural or isolated regions, since these groups tend to have less access to hospitals and must rely instead on community clinics that are run mostly by nurses and physicians’ assistants.
In 2009, the University of Nevada School of Medicine ranked Nevada as 48th in the nation for number of physicians per capita. The Association of American Medical Colleges found that Nevada only has 218 physicians for every 100,000 residents — even lower than the already-low national average of 307 physicians per 100,000 people.
Non-physician practitioners will now be able to ease that shortage in Nevada — but other states with a high number of poor and rural families aren’t so lucky. Christy Blanco, a nurse practitioner from Texas who started her own clinic to care for low-income women, has failed to entice a physician to oversee her practice for the last two years. Since the Lone Star State requires doctor supervision of nurse practitioners, that means Blanco’s clinic may as well not exist.
She expressed the frustration of wanting to help vulnerable Americans — but lacking the authority to do so — in an interview with Businessweek. “I’m trying to work for the poor,” Blanco said. “I’ve spent thousands of dollars of my own money [opening a clinic]. I have a waiting list of patients, and I have to tell them I can’t practice.”
That’s why practitioners like Blanco have been lobbying states to ease their restrictions on the services they can provide. But some of the biggest barriers to that effort are the very doctors that nurses and physician’s assistants are trying to gain more independence from.
A May survey found that only 17 percent of doctors favor making nurse practitioners patients’ main resource for primary care services — even though multiple studies have shown that nurse practitioners provide care on a comparable level as physicians. Physicians’ groups were also the biggest opponents of Nevada’s newly-passed law.
Doctors’ skepticism isn’t reflected by American patients. A Health Affairs study from February found that patients are “open to a greater role” for non-doctor primary care providers, especially in regions where physicians are hard to come by.
That will be a necessary shift as Obamacare is implemented. With over 25 million Americans expected to gain health coverage — and consequently consume more primary care services — under the law in the next decade, primary care doctors won’t be able to handle the patient load without help from nurse practitioners and physician assistants.
“With the addition of 40 million people to the primary care system, everyone’s expertise and contribution is needed,” wrote authors in a piece for the May issue of the Journal of the American Board of Family Medicine.
Nevada’s new law will go into effect on July 1st.