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Expanding Primary Care Through Nurse Practitioners

A soon-to-be implemented law in Kentucky alters the flexibility and scope of practice of nurse practitioners, allowing them to prescribe drugs (except those that are at high risk for abuse) without physician oversight after four years of direct supervision. This shift aims to mitigate the effects of a shortage of primary care physicians and has implications for California.

The law means that nurse practitioners, or NPs, will be able to operate independently, rather than through partnerships with physicians. It also establishes a system in which new NPs can identify physicians willing to collaborate with them during the four-year supervision period and for ongoing agreements to prescribe high risk drugs like certain pain killers.

While some praise the Kentucky law for its effort to expand access to care, others are critical, citing concerns that nurse practitioners may not have enough training or experience to catch and manage complex medical problems. This concern has some merit: what happens if a patient’s symptoms look like a duck, quack like a duck, but turn out to be a kakapo? Misdiagnoses can have serious consequences, but, frankly, physicians can misdiagnose patients as well. The Institute of Medicine found that no evidence that NPs provide care that is inferior or less safe than that provided by physicians.

Past efforts to expand scope of practice of mid-level practitioners in California have faced challenges in the legislature. SB 491 would have allowed NPs to practice independently of doctors after 4,160 hours of supervised practice, but it stalled in the appropriations suspense file late year.

Ultimately, it is likely that the Kentucky law will expand access to care by increasing the number of providers who offer routine health care services. These are lessons to be learned by California, especially given that the Bay Area Council Economic Institute recently found that expanding the scope of practice for NPs would result in 2 million more preventative care visits per year and would save $1.8 billion in the first ten years in California.

For more recommendations on healthcare workforce develop in California, see ITUP’s report. See this Kaiser Health News story for more on the new law in Kentucky.

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