Nurse practitioners: A boon for underserved areas

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.