Physicians to Newsom: Don’t sign AB 890
Physicians across the state, including those who are part of the Humboldt-del Norte County Medical Society, are calling on Gov. Gavin Newsom to veto a bill that would give nurse practitioners full practice authority, meaning the ability to run their own practice independent of doctor supervision.
The bill, written by North Coast Assemblyman Jim Wood (Dsanta Rosa) has already passed the Legislature and is awaiting a decision from the governor.
The bill is opposed by the California Medical Association, which the local medical society is a component of, and the American Medical Association.
Proponents of the bill lauded it as broadening access to care in rural areas, such as Humboldt County, where there are physician shortages.
Open Door Community Health Centers CEO Tory Starr is among the proponents.
“We are supportive of the bill because as a rural health provider the value of nurse practitioners to provide care to underserved areas is very important,” he said. “It is a clear way to improve access to services in rural areas.”
Starr said there are 20 nurse practitioners serving in Humboldt and Del Norte counties with Open Door who are supervised by “adequate numbers of physicians.”
But Dr. Stephanie Dittmer, a Fortuna-based family practice physician and the president of the Humboldt-del Norte County Medical Society board, said there is little evidence to support that claim.
“There has been no evidence across the 22 states that have full practice authority for nurse practitioners that demonstrates an increase of clinical providers to the rural areas,” Dittmer told the Times-standard,
adding later, “We do believe, both here locally at the Humboldt-del Norte County Medical Society and to the CMA, that we would not see an increase in nurse practitioners, specifically to this area.”
Dittmer said that if AB 890 does create expanded access to medical care, it potentially could be at the expense of patient safety. She points out the disparity in training.
“When they complete their nurse practitioner training and are hired onto their first job, (they have) completed 500 clinical hours,” Dittmer said. “When a physician, completes their medical training, which includes medical school and a residency, the minimum number of hours on average is about 20,000 hours of clinical training.”
The CMA website notes, “While the bill does include some additional training requirements for independent nurse practitioners, it is nowhere near the expertise gained from medical school and the three years of residency required of all physicians.”
Wood believes without the legislation will drive nurse practitioners away from California.
“What’s good for one population is good for all,” he told the Times-standard via email.
“Once they’ve met the requirements in this legislation, I’m confident they will go where the opportunities exist. As we speak, we’re losing NPS who want to practice independently to the other 23 states that allow it.” (Florida recently passed the legislation in March, making it the 23rd state.)
One worry, opponents say, is it will exacerbate what is called a two-tiered system. One tier with access to resources will see doctors with expertise, while a lower-income tier will see nurse practitioners who don’t have the same medical training and experience.
Dittmer said that model, which already exists, would “widen our gap and disparities of health care outcomes,” suggesting those with better access to better-trained physicians will fare better than those who see clinicians or nurse practitioners.
Wood counters that nurse practitioners are often the first person a patient will see “so they’re already providing it.”
“NPS want nothing more than the best outcome for their patients, and as physicians do, they will refer patients who need more specialized care,” he said.
The American Medical Association responds to that argument saying AB 890 would result in “improper specialty referrals by undertrained NPS.”
Dittmer also said that while the bill is said to be “cost-neutral,” it is likely to affect the medical malpractice insurance industry. Currently, nurse practitioners are covered by their supervising physician. When you take away the supervising physician, it means nurse practitioners will need to have separate, increased coverage to practice. That could increase costs for physicians.
It could also have repercussions in the local health care scene.
“The more malpractice insurance claims, the more expensive health care is, the harder it is to recruit and retain all clinical providers,” Dittmer said. “That particular aspect is not addressed in this bill.”