For all its progressive talk, California often walks regressive paths. One example is the state’s paternalistic restriction on nurse practitioners (NPs), who are advanced practice registered nurses with post-graduate degrees. California is among the minority of US states, and the only western state, to require NPs to work under physician oversight. In doing so, California has effectively created a feudal system under which physicians get to earn unnecessary stipends even when patients don’t request their participation.
California consumers should be permitted to make their own health care decisions and to choose their own health care providers without having to pay a fee to third parties they don’t choose. But right now state law doesn’t permit that choice. That restriction not only inhibits patient freedom but also reduces access to care, raises prices, decreases the use of primary care services, constrains NP employment, and boosts hospitalization and emergency department visits. Nowhere is access more affected than in rural areas, which generally are under-served by physicians. So long as California law tethers NPs to physicians, fewer NPs are able to serve rural populations.
Fortunately, State Assemblymember Jim Wood has introduced Assembly Bill 890 to allow NPs to practice to the full extent of their education and training. According to Wood, AB 890 would improve health care access for millions of Californians who now have coverage but struggle to find healthcare providers, and according to the California Health Care Foundation, a projected gap in physician supply in California that is expected to meet less than half the demand for primary care in 2030 could be filled by projected growth in NP and physician assistant supply.
Dozens of studies demonstrate no difference in NP care when there is no physician oversight, but even if such studies did not exist, consumers should have the right to choose an NP if they want to. After all, NPs are trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose illness and disease, prescribe medication, and formulate treatment plans. And patients should have the choice!
The 21st century in California is no time and place for paternalism or feudalism. Liberating NPs to practice to the full extent of their education and training would improve access and reduce costs, hospitalizations and emergency-room use. In the spirit of Independence Day, California legislators should embrace AB 890 and free the state’s nurse practitioners!
Govern For California supports lawmakers who legislate in the general interest.