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Research & Commentary: Florida Considers Expanding Role for Qualified Nurse Practitioners

February 21, 2020

In this Research & Commentary, Matthew Glans examines a new bill in Florida that would expand the scope of practice of advanced practice registered nurses.

Strict licensing standards have become a significant barrier to entry in too many fields. Unfortunately, this is producing a dire doctor shortage. State boards control licensing standards, professional discipline, and the various costs associated with entering the medical profession. In many instances, these standards are supported by existing practitioners to block entry of new competitors. 

The United States faces a growing shortage of licensed physicians. Indeed, the Association of American Medical Colleges (AAMC) estimates the United States will have a doctor shortage of 122,000 physicians by 2032. According to the AAMC, Florida had 265.2 physicians actively providing direct patient care per 100,000 population in 2018.

Despite being the third most populous state in the nation, Florida only ranks 31st highest in physician to population ratio (86.8 primary care physicians providing direct patient care per 100,000 population). According to the Florida Department of Health, the shortage is likely to become worse, because 12.5 percent of Florida’s physicians reported they are planning to retire within the next five years.

One reform proposal that could help address this issue, supported by the Institute of Medicine and National Governor’s Association, would expand the scope of responsibilities for nurse practitioners (NP),by allowing NPs to provide more health care services. This extension would only apply to registered nurses who have also received a graduate degree in nursing. Allowing NPs to administer care would greatly reduce the upcoming doctor shortage. It would also reduce costs and increase access to quality health care. 

According to Floridians Unite for Health Care, 30 states and the District of Columbia have similar bills to increase the scope of practice allowed to nurse practitioners and advanced practice registered nurses (APRN). APRNs are trained to provide a range of medical services including disease diagnosis, treatment, and prescription medication orders. Allowing APRNs and nurse practitioners to administer more health care services would greatly improve health care access while reducing costs.

A bill being considered in Florida, HB 607, would “authorize APRNs who meet certain criteria to engage in autonomous practice and perform specified acts without physician supervision or supervisory protocol.” The bill would ensure quality care by including strong standards for clinical instruction or practice under supervision by a doctor. The bill would also lower restrictions placed on physician assistants, giving them greater autonomy as well. The bill would also create an advisory committee comprised of physicians and APRNs to define the scope of practice for autonomous APRNs and requires APRNs or PAs to report adverse incidents that impact patients.

Although critics claim expanding the scope of practice for APRNs will reduce overall quality of care, a 2012 article in Health Affairs reviewing 26 studies on the topic noted the “health status, treatment practices, and prescribing behavior [of APRNs] were consistent … [with those of] physicians.” Furthermore, a 2015 study in the International Journal for Quality in Health Care found “few differences in primary care provided by APNs and physicians; for some measures APN care was superior.”

The following articles examine the doctor shortage, scope of practice, and medical licensing from varied perspectives.
 

Quality of Primary Care by Advanced Practice Nurses: A Systematic Review
https://www.mc.vanderbilt.edu/documents/nursingoap/files/Quality%20of%20Primary%20Care%20Advanced%20Practice%20Nurses.pdf
In this study, published in the International Journal for Quality in Health Care, the authors conduct a systematic review of randomized controlled trials of the safety and effectiveness of primary care provided by advanced practice nurses and evaluate the potential of their deployment to help alleviate primary care shortages.

Healthcare Openness and Access Project: Mapping the Frontier for the Next Generation of American Health Care
https://www.heartland.org/publications-resources/publications/healthcare-openness-and-access-project-mapping-the-frontier-for-the-next-generation-of-american-health-care
The Healthcare Openness and Access Project (HOAP) is a collection of state-by-state comparative data on the flexibility and discretion U.S. patients and providers have in managing health care. HOAP combines these data to produce 38 indicators of openness and accessibility. The project provides state-by-state rankings over a number of variables, including occupational licensing.

End State Licensing of Physicians
https://www.cato.org/publications/commentary/end-state-licensing-physicians
Shirley Svorny of the Cato Institute argues in this article for the ending of state licensing for physicians. Svorny says the state licensing system is both costly and unneeded. “The benefits of state licensing are overstated. Licensing authorities verify education and training, but little else. State licenses do not indicate an individual physician’s specialty-specific skills. Specialty certification is the purview of medical specialty boards, which are private,” wrote Svorny.

Medical Licensing: An Obstacle to Affordable, Quality Care
http://heartland.org/policy-documents/medical-licensing-obstacle-affordable-quality-care
Shirley Svorny of the Cato Institute argues licensure not only fails to protect consumers from incompetent physicians, it also makes health care more expensive and less accessible by raising barriers to entry. Only institutional oversight and a complex network of private accrediting and certification organizations, all motivated by the need to protect reputations and avoid legal liability, offer whatever consumer protections exist today. 

Reform for a Healthy Future: Expanding Scope of Practice for Nurse Practitioners in Texas
https://www.texaspolicy.com/library/doclib/2014-05-PP19-ScopeofPractice-CHCP-JohnDavidson.pdf
In this Policy Perspective, John Davidson of the Texas Public Policy Foundation argues Texas’ medical practice laws are highly restrictive compared to many other states and incentivize NPs to practice elsewhere, thereby exacerbating a growing provider shortage in the state.

The Medical Monopoly: Protecting Consumers or Limiting Competition?
http://heartland.org/policy-documents/medical-monopoly-protecting-consumers-or-limiting-competition
Sue A. Blevins of the Cato Institute examines the effect of government health care policies on the health care market. Blevins finds licensure laws appear to limit the supply of health care providers and restrict competition to physicians from non-physician practitioners. The primary result is an increase in physician fees and income, driving up health care costs. 

Medical Licensing in the States: Some Room for Agreement – and Reform
http://www.cato.org/blog/medical-licensing-states-some-room-agreement-reform
Charles Hughes of the Cato Institute discusses the growing doctor shortage, how it is likely to increase with the implementation of Obamacare, and the steps some states are taking to address the issue. 

A Cure for what Ails Us
http://heartland.org/policy-documents/cure-what-ails-us
Justin Owen, Trey Moore, and Christina Weber of the Beacon Center of Tennessee analyze the current predicament facing Tennessee policymakers in the wake of the Affordable Care Act. The report also offers state-led solutions that would move the nation’s health care system in the proper direction, treating the diseases that weaken the system themselves, rather than merely treating symptoms. 

Six Reforms to Occupational Licensing Laws to Increase Jobs and Lower Costs
http://heartland.org/sites/default/files/occupational_licensing.pdf
Byron Schlomach of the Goldwater Institute argues reforming licensing could open career opportunities and reduce costs without sacrificing consumer safety. The paper recommends six reforms. 

 

Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this subject, visit The Heartland Institute’s website, and PolicyBot, Heartland’s free online research database.

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Author
Matthew Glans joined the staff of The Heartland Institute in November 2007 as legislative specialist for insurance and finance.