One of the interesting stories to watch in the coming months in the states is the fight over “scope of practice.” That means: who gets to do what, and under whose supervision. It basically pits doctors against other health care providers – nurses, nurse practitioners, physician assistants, etc. They are sometimes called “extenders” or “non-physician providers.” (There are also big fights within dentistry.)
These fights would heat up even without the Affordable Care Act – you’ve all heard about the shortage (in some communities at least) of primary care physicians. And you know there is an aging population that is going to need access to primary care. Throw in the health care law – millions of newly insured people entering the system, as well as delivery system reforms and care innovations that encourage more primary care, care coordination and team-based medicine that invites a larger role from those “extenders.” (Can you tell I don’t like that word?)
But state law – some state laws – may limit what these health care workers can do or require so much supervision by a physician that it is tantamount to a limit. The nurses and physician assistants use the phrase “practice to the top of their license” to mean they want to be able to do everything they are trained and licensed to do. There also are questions about how insurance plans address these different kinds of providers, and what options/explanations/information patients are given about who they are going to see at any particular juncture in their care.
In my next Covering Health post, I will share two recent stories I liked a lot about the changing role of nursing (which isn’t the only scope-of-practice fight but it’s the one you hear most about). First I want to provide some resources and thoughts on how to cover this topic more broadly.
Keep in mind that there are national trends but it’s a state-based legal problem. Continue reading