...In 2014, when the new federal health care law extends insurance coverage to 30 million more people, the doctor shortage is likely to get worse. Anticipating this, states and the federal government are offering repayment of medical school loans and other incentives to encourage newly minted doctors to practice primary care in needy areas.
But efforts like these take years to pay off. So as an additional step, states are trying to loosen decades-old licensing restrictions, known as "scope of practice laws," that prevent nurse practitioners from playing the lead role in providing basic health services.
Nurse practitioners, registered nurses with advanced degrees, are capable of providing primary-care services such as diagnosing and treating illnesses, prescribing medication, ordering tests and referring patients to specialists. But only 18 states and the District of Columbia currently allow nurse practitioners to perform these services independently of a doctor.
A 2010 Institute of Medicine report
, "The Future of Nursing," cited nearly 50 years of academic studies and patient surveys in concluding that primary care provided by nurse practitioners has been as safe and effective as care provided by doctors. But efforts to change "scope of practice" laws to give nurse practitioners more independence have run into stiff opposition...
...Instead of requiring supervision by a doctor, Virginia's new law requires nurse practitioners to be part of a doctor-led "patient care team." And instead of limiting doctors to overseeing just four nurse practitioners, the law allows them to work with up to six. Most important, it removes a requirement that doctors regularly work in the same location as the nurses they supervise. Instead, the statute allows doctors and nurses in separate locations to use telemedicine techniques to collaborate....
...The American Academy of Nurse Practitioners and other nursing organizations recently issued a position paper opposing the whole idea of requiring nurse practitioners to join a doctor-led team if they want to practice to the full extent of their training.
"We broadly support team-based care when it reflects the needs of patients, says Tay Kopanos, head of government affairs for the academy. But when a nurse practitioner can't bring her best efforts to a clinic without joining a doctor's team, Kopanos says, "we do not support it."