Nurse Practitioners and Healthcare Reform

Nurse Practitioners and Healthcare Reform

More setbacks for S.B. 491

By Genevieve M. Clavreul, RN, Ph.D.
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S.B. 491, a bill that would allow nurse practitioners to practice without a physicians’ supervision, has stalled again. The bill finally passed out of the Assembly’s Business, Professions and Consumer Protection Committee by a 6–3 vote, with five committee members abstaining. The bill then found itself placed in the suspense file of the Appropriations Committee, which means no further action will occur during this legislative session. In short, the bill is “dead” at least for now.

Support Withdrawn
S.B. 491 passed the Business, Professions and Consumer Protection Committee only after concessions and amendments were added that would allow nurse practitioners to operate independently only if they practice at a hospital, clinic, nursing home or other medical facility.
    AARP, which had supported the measure, dropped its support following the amendments. The American Association of Nurse Practitioners also withdrew its support for the same reason, saying that the changes made “would not only retain the status quo, but impose added barriers to patients and the provider community.”

Nurses Fill a Void
This bill was considered significant because there has been a general consensus since the passage of the Affordable Care Act that without expanding the scope of practice of healthcare providers such as nurse practitioners, physician’s assistants and other advance practice professionals, California will not have enough providers to meet the medical needs of the individuals who will now have health insurance.

The CMA’s Response

However, not everyone has been supportive of attempts to expand the scope of practice for nonphysicians. The California Medical Association (CMA) has been a particularly vocal opponent of S.B. 491. In August, CMA President Paul Phinney, M.D., told the Los Angeles Times that the bill would allow “nurse practitioners to diagnose and treat patients beyond their capabilities and without any additional training, jeopardizing patient safety.” 


NPs are a Better Bet, Says Economist

by Mackenzie Stewart

In a March 2013 interview with NPR, University of California, San Francisco, healthcare economist Joanne Spetz weighed in on nurses practitioners versus physicians. She said that from a policy perspective, nurses are a better bet. 

"Nurse practitioners are more likely to practice in settings that serve large shares of Medicaid patients, and are somewhat more likely to practice in rural communities," Spetz explained. Nurse practitioners can be trained much more quickly than a physician, and their compensation is lower, she added.

"So, when a legislature is looking at the insurance of hundreds of thousands of people and the demand for care that those people are going to have, getting health professionals to meet their needs as quickly as possible and as cost-effectively as possible is a real need," she said.

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