NCPA - National Center for Policy Analysis


April 15, 2010

Newly insured patients will be looking for doctors and may find nurses instead, says the Associated Press (AP). 

With a looming shortage of primary care doctors, 28 states are considering expanding the authority of nurse practitioners.  These nurses with advanced degrees want the right to practice without a doctor's watchful eye and to prescribe narcotics, says the AP. 

The medical establishment is fighting to protect its turf:  

  • In some statehouses, doctors have shown up in white coats to testify against nurse practitioner bills.
  • The American Medical Association says a doctor shortage is no reason to put nurses in charge and endanger patients. 

Nurse practitioners argue there is no danger: 

  • They say they are highly trained and as skilled as doctors at diagnosing illnesses during office visits.
  • They know when to refer the sickest patients to specialists, they say, plus, they spend more time with patients and charge less (Medicare, which sets the pace for payments by private insurance, pays nurse practitioners 85 percent of what it pays doctors). 

 States regulate nurse practitioners, and laws vary on what they are permitted to do: 

  • In Texas, nurse practitioners must collaborate with doctors to diagnose patients and prescribe medications.
  • For the past decade, however, nurse practitioners have been discussing ways to expand their role with the Texas Medical Association, which represents physician interests. 

Source: John Smierciak, "28 states seek to expand the role of nurse practitioners," Dallas Morning News, April 14, 2010.


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