In summary

Assembly Bill 890 will remove restrictions on patient access to nurse practitioners and help fill California’s primary care provider gap.

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By Matthew S. Schechter, Special to CalMatters

Dr. Matthew S. Schechter is a board certified OB/GYN and works as an obstetric hospitalist and HPV specialist in Oakland,

Does it make sense to restrict patient access to primary care nurse practitioners during a pandemic?  The answer is obvious.  

Yet that is what the California Legislature will do if Assembly Bill 890 fails to pass.

We live in a time of medical scarcity – shortages of tests, masks and ventilators across the state.  Most worrisome during a pandemic: a shortage of health care providers able to meet the surge of Californians who will need care in the coming years.  

The provider shortage is not new, but it has grown dramatically in recent years.  While the Affordable Care Act cut the uninsured population in half, the workforce did not keep pace with growth.  Over the last decade, the number of primary care providers per insured Californian went down by one-third.  Thanks to the nightmare of COVID-19, in the coming months we’ll have an unprecedented need for frontline providers.  

Fortunately this spring, the California Assembly passed AB 890, a bill to remove restrictions on patient access to nurse practitioners.  NPs are emerging leaders in California’s primary care workforce and expanded access has the potential to close our state’s primary care provider gap, especially in urban centers and communities of color hit hardest by this pandemic.  

Nurse practitioners are fully licensed and board certified and lead the nation in high quality, high value care.  In my own practice, I regularly work side-by-side with nurse practitioners who have outstanding clinical outcomes, publish peer-reviewed research and are beloved by their patients.  Study after study demonstrates that nurse practitioners have patient outcomes as good or better than doctors and save health systems money in so doing.

Thirty-eight other states have already acknowledged nurse practitioners’ value by removing practice restrictions on nurse practitioners, including 22 states with fully independent practice.  Every state west of the Rockies other than California and Utah have independent NP practice.  Unsurprisingly, states with full NP practice authority also have better health outcomes.  When it comes to the illogical suppression of NP practice, California has more in common with Texas, Oklahoma, Georgia and South Carolina than any of our 22 closest neighbors.  We shouldn’t borrow our health care policy from states with the worst health outcomes in the country. 

Current state law ties the hands of nurse practitioners by forcing experienced, licensed and boarded nurse practitioners to arbitrarily assign an MD “supervisor.”  This supervisor can then dictate the types of medical conditions a nurse practitioner treats, arbitrarily control their schedule, and even prevent nurse practitioners from seeing uninsured patients.  

Typically, nurse practitioners have to pay this loosely affiliated doctor a percentage of their earnings, but the “supervisor” has no obligation to actually participate in the care of patients.  The only actual requirement is that they are occasionally “available” by phone somewhere in the state.

Such anticompetitive supervision requirements do not improve patient care.  Nurse practitioners know their scope of practice like every other health care provider and have the same high standards for consultation when a clinical issue arises outside of their scope.  

Nurse practitioners are the only licensed, boarded health care professionals subject to this superfluous requirement.  State licensing boards trust literally all of the other independent health care professionals like optometrists, physical therapists and psychologists to consult a doctor when clinically indicated.  Our current laws mandating doctor “supervision” of NP’s are actually just a structural means for physicians to suppress NP practice, and they’re rooted in the traditional gender hierarchy in health care.

Pandemics have a way of clarifying priorities in health care.  Patriarchal protectionism like this might be acceptable in other states that don’t share our values, but California should instead look at the decades of research demonstrating safety, competence and value of our nurse practitioner workforce. The California Senate and Gov. Gavin Newsom should pass AB 890 into law now so our health care workforce can surge in the coming months to years and meet the tsunami of need in our state.  

Don’t make it harder for patients to find a health care provider during a pandemic.

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