NCPA - National Center for Policy Analysis

The Doctor's Out. Where's the Nurse?

November 10, 2011

There is a looming physician shortage.  Nonphysician primary care providers, or nurse practitioners, could help fill the gap.  Nurse practitioners have more advanced training than licensed vocational nurses or registered nurses, often earning a doctorate in their field before entering the workforce.  This gives them the ability to diagnose and treat ailments much like a primary care physician, say Virginia Traweek, a graduate student fellow, and John C. Goodman, President and CEO and Kellye Wright Fellow, at the National Center for Policy Analysis.

Unfortunately, nurse practitioners are severely limited in some states.  Although scope of practice laws vary widely, the contrast of Oregon and Texas laws shows the problems associated with restrictive practice guidelines.  Under Texas law, a nurse practitioner must be supervised by a doctor.  Further:

  • A physician cannot oversee more than four nurse practitioners at one time.
  • The nurse practitioners must be located within 75 miles of the doctor's office.
  • The supervising doctor must randomly review 10 percent of the nurse practitioner's patient charts each month.

In Oregon, by contrast, nurse practitioners with the proper credentials and license may open their practice anywhere they choose and provide the same services as a primary care physician without oversight from any other medical professionals.

These regulations have the greatest impact on the poor, especially the rural poor.  This problem might be alleviated if nurse practitioners were allowed to practice independently in rural areas.  But, under Texas law, these practices must be located within 75 miles of a supervising physician.

Many physicians are concerned that the quality of care patients receive will suffer if patients are treated by less qualified personnel.  However, when appropriate, some patients may prefer having the choice to receive treatment for minor conditions in a more convenient setting, such as a retail clinic with evening hours, even if it is by someone other than a traditional medical doctor. 

Source: Virginia Traweek and John C. Goodman, "The Doctor's Out.  Where's the Nurse?" National Center for Policy Analysis, November 10, 2011.

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