The American Medical Association is strongly urging California Governor Gavin Newsom to veto a bill that would allow nurse practitioners (NPs) to practice without physician supervision.
In a letter sent to Newsom earlier this month, AMA Executive Vice President and CEO James L. Madara, MD, explains the AMA’s position on the bill, A.B. 890, stating that it “will not expand access to care in rural and underserved areas, increases overall healthcare costs and threatens the health and safety of patients in California.”
On the first point, Mandara uses the example of Oregon, noting that while that state has long allowed independent practice for NPs, “there is no measurable shift of nurse practitioners to the rural areas.”
In fact, he writes, states that require physician-led, team-based care “have seen a greater overall increase in the number of nurse practitioners compared to states that allow independent practice.”
The fact that NPs tend to prescribe 20 times more opioids and more than 400% more diagnostic imaging examinations than physicians is indicative that the bill will raise healthcare costs, Madara writes.
Moreover, he points out, “researchers have found that greater coordination in healthcare teams may produce better outcomes than merely expanding nurse practitioner scope of practice alone.”
As for threatening patients’ safety, Madera concedes that NPs are essential members of physician-led care teams but lack the training to practice independently. “But it is more than just the vast difference in hours of education and training,” Madara writes. “It is also the difference in rigor and standardization between medical school and residency and nurse practitioner programs.”
The AMA’s letter cites and quotes an assessment of the bill by Lawton R. Burns, PhD, which was submitted to the California Senate Appropriations Committee. The assessment examines three practice functions allowed in accordance with the original Senate version of the bill: prescribing opioids, prescribing antibiotics and reading mammograms.
In his assessment, Burns—who chairs the Department of Health Care Systems at the University of Pennsylvania Wharton School of Business in Philadelphia—deems these practice functions “not entirely favorable to the public’s health.”
The element of the bill that allows for them “will likely lead to greater fragmentation and dispersion of care, higher healthcare costs, and perhaps higher patient mortality among patients receiving these services,” Burns concludes.
Read the full letter here.