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Expanding the role of nurse practitioners should be low-hanging fruit for health-care reform | Opinion

There are realistic ways to improve patient care, one of which costs nothing and enjoys bipartisan support.

Nurse practitioners can help fill the U.S.'s growing primary care gap, write Tom Daschle and David Hebert.
Nurse practitioners can help fill the U.S.'s growing primary care gap, write Tom Daschle and David Hebert.Read moreFatCamera / Getty Images

Health care will dominate the 2020 elections. It’s the top issue for millions of voters. And the two parties couldn’t be farther apart.

Many Democrats want to establish a Medicare for All system or a “public option” to enable the government to expand coverage and drive down health-care costs. Meanwhile, many Republicans want to strike down the Affordable Care Act and its regulations in the hopes that less government and more competition will reduce costs.

Partisans can argue about the merits of each approach until they’re blue in the face. But there’s no question that both proposals would prove enormously disruptive, take years to fully implement, and potentially leave some Americans worse off.

Fortunately, there are many ways to improve all patients' access to care. One of which costs nothing. And it enjoys bipartisan support.

That solution? Enable all clinicians to practice to the full extent of their education and clinical training. That would expand every patient's access to high-quality care now.

America suffers from a severe shortage of primary care. Right now, 78 million U.S. residents live in Health Professional Shortage Areas (HPSAs), which the federal government defines as having more than 3,500 patients for each primary-care provider. Sixty percent of these areas are rural.

The problem grows worse each day. Currently, the United States is short about 14,000 primary-care physicians. But that figure could grow to more than 49,000 by 2030, according to a report by Peter Buerhaus, Ph.D., published by the American Enterprise Institute.

Nurse practitioners and other practitioners are well-positioned to solve this crisis -- and in some areas, already are. NPs complete both undergraduate and graduate-level academic and clinical training, including a master’s or doctoral degree, pass national certification exams and receive board certification, and meet state license requirements to practice. This training prepares them to evaluate and diagnose patients, order and interpret diagnostic tests, and prescribe medications in all 50 states. Importantly, more than 85% of NPs are trained in primary care -- including pediatric, geriatric, and women’s health.

They provide outstanding care to patients. Study after study finds that NPs achieve patient outcomes equivalent to physicians, according to the National Academy of Medicine. And, patient satisfaction with NPs consistently ranks high.

Nurse practitioners already shoulder much of the primary-care burden in America. Last year, the ranks of NPs grew to a record 270,000, and they conduct more than one billion patient visits annually. Between now and 2030, the NP workforce is projected to grow by 6.8% annually, according to Buerhaus. By comparison, the physician workforce is expected to grow just 1.1% annually.

Unfortunately, just 21 states and the District of Columbia license NPs to the top of their education that allows them to provide primary-care services without unnecessary physician oversight. The rest impose unnecessary restrictions.

For instance, in 28 states, it’s illegal for NPs to practice without a “permission slip” in the form of “collaborative agreements” with physicians. These agreements needlessly impede patients’ access to high-quality NP care and increase health-care costs. Many states, most notably Missouri, even prevent NPs from practicing more than a few miles from their collaborating physician.

Such outdated regulations deter NPs from setting up shop in many areas of the country. Not surprising, states with restricted practice laws have 40% fewer NPs than states with full practice authority. By contrast, states with modernized licensure laws have recorded growth in the number of NPs joining the profession as well as the number of NPs working in rural and underserved areas.

Thankfully, policymakers are moving to retire these pointless restrictions.

In November 2018, the U.S. Department of Health and Human Services released a report -- in conjunction with the Treasury and Labor Departments -- that called on states to update their scope of practice laws. The National Academy of Medicine has recommended similar reforms. In October 2019, the administration also released an executive order that would lift barriers to NP practice in the Medicare program.

Politicians up and down the ballot have the power to help their constituents by supporting such commonsense, bipartisan reforms. Eight of the top 10 healthiest states in the United States have granted full practice authority for NPs, according to a UnitedHealth Foundation report. Meanwhile, the bottom 10 states all restrict NP practice.

Our great national debate about health-care reform won’t end anytime soon. But giving patients unimpeded access to highly trained professionals such as NPs ought to be low-hanging fruit. In the end, consumers should have access to a variety of health-care professionals. There are many patients who need care and we all need to work together.

Tom Daschle is cofounder of the Bipartisan Policy Center and a former Senate majority leader (D., S.D.) who served in Congress from 1979-2005. David Hebert is CEO of the American Association of Nurse Practitioners (AANP).