The author of a defeated measure that would have allowed California’s nurse practitioners to work independently of doctors says he will re-introduced the bill within two years.
Supporters of SB 491 say the measure could have helped to ease the existing shortage of primary care physicians. It's a problem that’s expected to worsen beginning Jan 1, when federal health law will require most Americans to have insurance or to pay a fine that starts out small, then grows over time. It's also when the state will extend Medi-Cal coverage to an estimated 1.4 million low-income Californians as part of the Affordable Care Act's expansion of Medicaid.
"I really believe that if we’re going to be mandating that everyone has health insurance, it’s our responsibility as policymakers to make sure they can see someone safely… and that they can have access to care," says Democratic Senator Ed Hernandez of West Covina, author of the failed bill.
Under current law, nurse practioners – who hold advanced degrees beyond what’s required of Registered Nurses - can, under a doctor’s supervision, prescribe medications and provide many of the same services as primary care physicians.
The California Medical Association (CMA), which represents more than 37,000 physicians statewide, says allowing nurse practitioners to work without direct physician oversight would risk patient safety.
Micah Weinberg, a health policy analyst with the Bay Area Council in the San Francisco Bay Area, disagrees.
"We’re not talking about nurse practitioners performing open heart surgery. We’re not talking about nurse practitioners performing brain surgery," he says. "We’re talking about nurse practitioners providing high quality primary care, which they have been trained extensively to be able to do."
Others who support allowing nurse practitioners to practice independently say this isn’t a radical idea. They point to 17 other states and the District of Columbia, where nurse practitioners are already allowed a measure of independence from doctor supervision.
Weinberg says its time for California to do the same. “It’s something that we should have done already," he says. "It's a common sense issue that should not be as controversial as it is.”
“It’s absolutely true nurse practitioners do a great job. We need more of them," says CMA President, Dr. Paul Phinney. "But they shouldn’t be practicing independent of physicians."
Primary care physicians have about 24,000 hours of clinical training compared to about 4,000 hours for a nurse practitioner. That difference, Phinney says, can affect patient safety and quality of care. What’s more, he adds, allowing nurse practitioners more independence does nothing to ease the doctor shortage.
"The argument that granting nurses independent practice will dramatically and quickly increase access is false because they're not sitting on the sidelines now," Phinney says, adding that most, including his own nurse practitioner, have full patient loads.
A better solution, Phinney says, lies in more integration between doctors and nurse practitioners - not less. He cites as an example a similar scope of practice measure, also authored by Senator Hernandez, that would allow pharmacists to provide more patient care, but in collaboration with doctors. That measure, SB 493, is expected next week to land on Gov. Jerry Brown's desk for final approval.
"A team approach is not only better from the quality standpoint – because you have more people looking at the care but it also is more efficient," Phinney says. " You can get more done with a team than you can with individual practioners that are incompletely separate environments."
Meanwhile, Hernandez isn't giving up the fight. He says he plans to re-introduce SB 491 within two years.