California Nurse Practitioners Experience Major Legislative Setback

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CNP-thumb1The precarious legal situation in the ongoing battle to expand the powers of nurse practitioners in California has reached a point of immovability, reports Melanie Mason in the Los Angeles Times.

Democrat Sen. Ed Hernandez’s bill, which was designed to give NPs the power “to practice without the direct supervision of a physician,” didn’t make it past committee last Friday, mainly because of physicians lobbyist group the California Medical Association.

According to Mason, “The organization teamed with some specialists and labor unions to mobilize lobbyists, engage doctors across the state, and even dedicate Twitter accounts as it waged its campaign against the bill.” This, after “the group supported a separate measure to permit nurse practitioners and some other non-physicians to perform first-trimester abortions, which lawmakers passed and sent to Gov. Jerry Brown last week.”

Hernandez said one word stalled the bill: “independent.” That was “the sticking point… For organized medicine, that’s the…line in the sand.”

This ongoing argument, as we’ve discussed before, revolves around the physician-shortage crisis, which is just as potent in California as it is elsewhere in the country. Out of the state’s 58 counties, only 16 have enough primary-care doctors, Mason reports. If nurse practitioners could practice independently of a physician’s purview, NP supporters argue the crisis would be eased and there would be better management of the scores of newly insured patients entering the system next year.

However, in this particular legislative battle, the physicians pointed out “the bill made no assurances that independent nurse practitioners would work in underserved areas. And they argued that letting the practitioners, who have fewer years of education and clinical training than doctors, work without oversight would put patients at risk.”

The California Medical Association was firm in its stance that NPs need to work “more closely with physicians, not independently,” even after Hernandez revised the proposal to specify settings in which NPs would have autonomy. However, this revision only caused the bill to lose the support of major groups like the AARP and the American Association of Nurse Practitioners.

Not unexpectedly, there was also a great deal of money backing the physicians association’s opposition, a significant percentage of which went to campaign contributions for principal legislators. As a result, proponents of the bill felt they “were always on defense.”

Although Hernandez is saying “the fight is not over,” this is a significant setback for extenders in a state that is leading the country into the healthcare reform era.

As healthcare executives, do you believe the roles of NPs need to be expanded in order to fill the physician shortage? From talking with your physicians and with your extenders, what is the compromise that can be reached to resolve this battle, which is consuming a great deal of time and money around the country?

-by Pete Fernbaugh

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