Nurse prac­ti­tion­ers: A boon for un­der­served ar­eas

Marysville Appeal-Democrat - - OBITUARIES / LOCAL -

Let nurse prac­ti­tion­ers in Cal­i­for­nia have al­most all of the author­ity that doc­tors now pos­sess, urges the state Se­nate via a pro­posed law it has al­ready cleared.

If this bill passes the As­sem­bly un­changed and then is signed by Gov. Jerry Brown, warns the doc­tors’ lobby, what would be the point of spend­ing 10 to 12 years study­ing and train­ing to be­come a physi­cian? MDs and their sup­port­ers also won­der how many pa­tients with po­ten­tially se­ri­ous ail­ments will pre­fer to see some­one who stud­ied and trained six or seven years in­stead of a full-fledged doc­tor.

But, say sup­port­ers of full em­pow­er­ment for nurse prac­ti­tion­ers, many of them al­ready per­form the ba­sic func­tions of pri­mary care physi­cians, things like giv­ing phys­i­cal ex­ams, pro­vid­ing di­ag­noses, order­ing lab­o­ra­tory tests, pre­scrib­ing most drugs and re­fer­ring pa­tients to spe­cial­ists. They now work un­der su­per­vi­sion from MDs, but they’re still per­form­ing those tasks and many get only cur­sory over­sight be­cause doc­tors trust them.

While this de­bate rages in Sacra­mento and around the state, some parts of Cal­i­for­nia are cur­rently far un­der­served on the med­i­cal front.

Re­cent num­bers from the Cal­i­for­nia Health Care Foun­da­tion show huge dis­par­i­ties be­tween var­i­ous re­gions in the num­bers of both pri­mary care doc­tors and spe­cial­ists.

Ex­am­ple: While the San Fran­cisco Bay Area has 78 pri­mary care physi­cians and 155 spe­cial­ists for ev­ery 100,000 res­i­dents, the In­land Em­pire re­gion of River­side and San Bernardino coun­ties has but 40 pri­mary care doc­tors and 70 spe­cial­ists for ev­ery 100,000.

This is be­cause med­i­cal school grad­u­ates in­creas­ingly pre­fer to live in the state’s largest ur­ban ar­eas, in and near San Fran­cisco, San Diego and Los An­ge­les. Which sug­gests a com­pro­mise so­lu­tion to the de­bate over the pow­ers of nurse prac­ti­tion­ers: Give them full author­ity in un­der­served ar­eas, in­clud­ing the San Joaquin Val­ley and coun­ties like Del Norte, Siskiyou, Modoc and Hum­boldt, where physi­cians are rel­a­tively scarce.

In fact, the chief leg­isla­tive ad­vo­cate for more nurse prac­ti­tioner author­ity, Demo­cratic Sen. Ed Her­nan­dez of West Cov­ina, uses th­ese scarci­ties as a chief ar­gu­ment. “About onethird of our coun­ties…have huge short­ages,” he said in an in­ter­view. “Nurse prac­ti­tion­ers could fill that void.”

Giv­ing them in­creased author­ity in the most med­i­cally un­der­served ar­eas makes sense. For one thing, it would be strong mo­ti­va­tion for more nurse prac­ti­tion­ers to set­tle in those ar­eas, while also pro­vid­ing de­pend­able ba­sic ser­vice for their res­i­dents. Nurse prac­ti­tion­ers have a solid record in the 21 states where they now have full author­ity, with few mal­prac­tice ac­tions against them.

The move to beef up re­spon­si­bil­i­ties of nurse prac­ti­tion­ers is part of a gen­eral shift to­ward em­pow­er­ing health care pro­fes­sion­als who are not physi­cians. Last year, a Her­nan­dez bill au­tho­rized phar­ma­cists to ad­min­is­ter drugs and other prod­ucts or­dered by doc­tors, as well are pro­vid­ing con­tra­cep­tives and some other drugs with­out a physi­cian’s pre­scrip­tion. They also can give vac­ci­na­tions and eval­u­ate tests that mon­i­tor the ef­fi­cacy of pre­scribed drugs. So far, no prob­lems.

Her­nan­dez, a long­time op­tometrist, also tried last year to win pas­sage of sim­i­lar in­creased author­ity for his own col­leagues and full pow­ers for nurse prac­ti­tion­ers. “We just don’t have enough pri­mary care physi­cians to do th­ese kinds of things any­more,” he said, “be­cause med­i­cal school grad­u­ates in­creas­ingly want to be­come spe­cial­ists.”

Her­nan­dez op­poses grant­ing nurse prac­ti­tion­ers author­ity to op­er­ate in­de­pen­dently only in un­der­served ar­eas, but said he would back in­cen­tives en­cour­ag­ing more doc­tors to move into those places.

But he’s al­ready ac­cepted one com­pro­mise, amend­ing his bill to re­quire that nurse prac­ti­tion­ers op­er­at­ing with full author­ity must be af­fil­i­ated with a med­i­cal group or hos­pi­tal.

Giv­ing them added pow­ers in un­der­served ar­eas would help solve short­ages in those re­gions, while leav­ing in place most cur­rent in­cen­tives to be­come an MD.

It’s the sen­si­ble way to go in an era of in­creased pa­tient loads un­der the Af­ford­able Care Act, bet­ter known as Oba­macare. ThomasD. Eliaswrites onCal­i­for­nia pol­i­tic­sand oth­eris­sues.

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