Nurse Practitioners in Massachusetts lobbying for full practice authority

America is facing a significant physician shortage and according to experts, the problem is going to increase in the coming years. 

One study conducted by the American Association of Medical Colleges predicts that by 2025, there will be a shortage of between 14,900 and 35,600 primary care physicians. These numbers, combined with the fact that America’s population is growing increasingly older presents a serious healthcare dilemma.  

Without enough physicians on hand and a growing number of people in need, access to high-quality care may decrease. To combat these challenges, 28 states and the District of Columbia have passed legislation to give nurse practitioners full practice authority. 

What is full practice authority?

Full practice authority allows nurse practitioners to diagnose and treat patients, order diagnostic tests, write prescriptions, and develop custom treatment plans under the authority of the state board of nursing. It also prevents the need for direct oversight from a physician. 

Five of New England’s six states already grant full practice authority to nurse practitioners, but Massachusetts does not. Industry experts say Massachusetts has some of the strictest laws governing nurse practitioners, which makes it difficult for them to care for patients freely. Additionally, patient advocates say all the red tape prevents individuals from accessing the care they need, while driving up costs. 

In response, some nurse practitioners are leaving the state altogether and establishing their own practices in nearby states like Connecticut and Vermont. Others are reevaluating their careers altogether and deciding to leave the medical field. 

What makes Massachusetts’ laws so restrictive?

Under current Massachusetts state law, all nurse practitioners must:

• Register with the Department of Public Health
• Have a supervisory agreement with a physician in place to prescribe Schedule II-IV drugs
• Undergo “retrospective reviews” if prescribing Schedule II drugs
• Avoid interpreting laboratory results (even if the NP ordered them)
• Follow additional guidelines when administering vaccines, immunizations, and performing other types of specialty care.

While these requirements may not seem especially restrictive on the surface, research conducted by Nurse Practitioner Schools suggests they present serious problems over time, including:

• Insurance reimbursement challenges
• Patient confusion
• Lack of access to healthcare for those living in rural and underserved communities
• Hiccups in the continuity of care
• An exodus of qualified, talented medical professionals from the state

Stephanie Ahmed, state legislative policy director for the Massachusetts Coalition of Nurse Practitioners recently told the Boston Globe that establishing a supervisory agreement with a physician is particularly burdensome. 

Ultimately, it requires physicians to review hundreds of prescriptions for patients they’ve never met or worked with, which slows down the delivery of care and complicates matters further. 

How would granting full practice authority benefit the state of Massachusetts?

Experts say granting full practice authority to nurse practitioners in Massachusetts couldn’t come at a better time. The state already has 4,955 confirmed cases of COVID-19 and that number will undoubtedly increase in the coming weeks. By easing restrictions to care, nurse practitioners could provide much needed support to (and independent of) physicians who are already on the front lines of the coronavirus. 

The Massachusetts State Senate has proposed a bill to address the physician shortage. Under the proposal nurse practitioners with at least two years of supervised practice experience could operate independently, without the oversight of a physician.

The bill’s author told WBUR that the relaxed guidelines would only last long enough to get Massachusetts healthcare system beyond the current pandemic. Once that happened, guidelines would revert to their original status. There’s still disagreement over the proposal, however, and it’s unlikely to pass.

Why the opposition?

Some senior state representatives say Governor Charlie Baker could pass this type of legislation via an executive order. Others oppose the idea because it would change the face of the healthcare landscape in response to an unprecedented situation. 

Even before the outbreak of coronavirus, the Massachusetts Medical Society said they too opposed granting nurse practitioners full practice authority. In a statement released on September 25, 2019, the society’s president Dr. Maryanne C. Bombaugh said “physician-led” teams should take care of patients, with nurse practitioners acting as support. 

Conclusion

Some say granting advanced practitioners and physician assistants full practice authority makes good medical sense. Others say it undermines physicians’ training and expertise. 

For the time being, it looks as though Massachusetts will prevent nurse practitioners from receiving full practice authority. However, as the coronavirus pandemic continues and the need for qualified healthcare providers rises, that may very well change. 

Here at NursingJobCafe, we’re following this story very closely. As more developments arise, we’ll make sure to keep you informed.