Readers React: Why freeing up nurse practitioners isn’t the answer to California’s doctor shortage

Mambo Muntanga, Susan Brown
A patient receives a flu shot from a nurse practitioner in Rockville, Md., in 2010.
(Evan Vucci / Associated Press)

To the editor: California is wrestling with a healthcare workforce shortage. That’s why the California Medical Assn. is leading the fight to secure more than $600 million in this year’s budget to ensure low-income and underserved residents have access to high-quality healthcare. (“California faces a doctor shortage. But doctors just derailed a plan to fix it,” column, May 17)

Despite columnist David Lazarus’ misunderstanding of the state’s healthcare crisis, we firmly believe that we can have both access and quality when it comes to healthcare. We know there are numerous ways that well-trained nurse practitioners can help improve care for patients.

But there is great variation in the quality and rigor of nurse practitioner training programs. Some obtain online degrees with virtually no clinical experience. There is no requirement in their training that nurse practitioners prove competency before being cleared to treat patients. Currently, that responsibility falls to the supervising physician. Assembly Bill 890 would have removed that important patient safeguard.

What Lazarus failed to mention was that in states that have given nurse practitioners more autonomy, the data show they do not in fact move into underserved communities in large numbers.


Nurse practitioners are an important part of the healthcare system, and we are open to discussions about how best to utilize and maximize their training and expertise. But we cannot trade access to care for quality.

David H Aizuss, M.D., Encino

The writer is president of the California Medical Assn.



To the editor: California missed the boat on this one.

The California Medical Assn. has no evidence of inferior care given by nurse practitioners, nor does it have evidence that “supervision” of nurse practitioners by physicians results in a higher quality of care. Many nurse practitioners focus on vulnerable populations, such as the homeless, those with mental illness and substance abuse problems, and those with other challenges affecting public health.

I believe the medical profession restricting the practice of other health professionals is wrong. Nurse practitioners have long ago charted this course, I for one with the full support of the best physician I ever have known.

As an independent Maryland nurse practitioner, I stand with California nurse practitioners and the physicians who support them.

Deborah Gootee, East New Market, Md.

The writer is a psychiatric nurse practitioner.

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