It's Time for Scope of Practice Reform

Michigan faces a widespread shortage of primary health care providers, and state rules on midlevel health care providers have held up a valuable solution to this problem. Nurse practitioners and physician assistants offer competent care in more locations and at a lower cost than physicians, but these professionals are limited by protectionist restrictions known as “scope of practice” rules. Policymakers should loosen these restrictions to make health care services easier to obtain and afford.

Scope of practice restrictions are defended as an attempt to raise standards of care by limiting the range of procedures a medical professional is licensed to perform. They also impose extensive training requirements, limit a professional’s ability to write prescriptions, and require costly annual license fees. A growing body of scholarship shows that the restrictions do more harm than good for patients and consumers.

New research is discovering that scope of practice restrictions result in higher costs by artificially increasing the income of providers through a rationing scheme that does nothing to improve the quality of care. The research indicates that access to care is improved when nurse practitioners and physician assistants can offer more procedures and operate more independently than current laws allow.

A working paper from the Mercatus Center at George Mason University in Virginia shows how restrictions on nurse practitioners and physician assistants raise health care costs. Expanding the scope of their practices reduces the cost of Medicaid outpatient claims by 11 percent, and improves patients’ access to health care with little effect on quality.

Access to affordable care will improve when we streamline regulations that allow physicians to delegate patient care to physician assistants. Michigan expanded the scope of practice for physician assistants in 2011. That reform enjoyed broad support within the health care industry, which lauded it as an important step toward greater efficiency and effectiveness in delivering care, but policymakers should not stop there.

In Michigan, a majority of counties are designated as Primary Medical Care Health Professional Shortage Areas by the U.S. Department of Health and Human Services, which compiled a list of counties with a higher-than-average ratio of residents per physician. The demand for nurse practitioners and physician assistants has grown tremendously in recent decades because, without these midlevel providers, many patients in underserved areas would get no care at all. Lawmakers should rely on the professional judgment of active practitioners and craft policies that enable nurse practitioners and physician assistants to help meet the needs of Michigan patients.