Editorial: Nurse practitioners can improve Californians’ access to healthcare

A nurse practitioner gives a shot at the Jefferson Hospital for Neuroscience on Oct. 8, 2018.
(Heather Khalifa/ TNS)

Thanks to the state’s embrace of Obamacare, California has expanded health insurance to millions of uninsured residents over the last five years. But as the number of people covered has grown, so has the strain on the doctors, clinics and hospitals that must respond to the increasing demand for care.

The problem is especially acute when it comes to primary care doctors and other front-line care providers, such as physician assistants and nurse practitioners. A study by UC San Francisco estimated that the state will have a shortfall of 4,700 of these clinicians by 2025. And the California Future Health Workforce Commission warned earlier this year: “Seven million Californians, the vast majority of them Latino, black and Native American, live in Health Professional Shortage Areas — a federal designation for counties experiencing shortfalls of primary care, dental care or mental health care providers.”

Given the circumstances, the state needs to make the fullest possible use of the healthcare professionals who are already trained and ready to help patients. That’s why the state Legislature should approve a long-sought bill (Assembly Bill 890 by Jim Wood, a Democrat from Healdsburg) to let nurse practitioners — registered nurses with extra years of training — offer the services they are certified to provide without requiring a doctor on hand to monitor them.

This seems like a no-brainer. Nurse practitioners in hospitals, clinics and medical groups would be free to provide the same care they do today, just without the requirement that a doctor be in the room or on call at the time the patient is treated. (That requirement currently applies to the 22,000 nurse practitioners in the state who are licensed to prescribe drugs.) Among other things, they could order tests, make diagnoses and prescribe certain drugs and medical devices, consistent with their training.


AB 890 would also create a state board to oversee the training and licensing requirements for nurse practitioners to operate their own offices, with no doctors on staff. Before hanging out a shingle, a nurse practitioner would have to gain an additional three years or 4,600 hours of clinical experience under a doctor’s supervision.

Sadly, the California Medical Assn. and a brace of other physicians’ groups are opposing AB 890, just as they opposed its precursors in 2013 and 2015. They complain that the bill’s provisions for assuring that nurse practitioners are competent to practice independently are too vague; they also say the state should build up the supply of doctors instead.

There’s no reason not to let nurse practitioners do more while also trying to increase the supply of primary care doctors — both are necessary. Nevertheless, supporters fear the opposition from physician groups will prevent the bill from escaping from the Assembly Appropriations Committee, where it faces a key test Thursday (the bill has already won the unanimous support of the relevant policy panel, the Assembly Business and Professions Committee).

Lawmakers shouldn’t let physicians’ jealousy over turf trump the needs of their constituents for care. That’s especially true for this Legislature, which is poised to extend insurance coverage to tens of thousands of additional Californians by making Medi-Cal available to all impoverished residents under age 26, regardless of immigration status. Coverage is meaningless if there’s no one available to provide the care you need.

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