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May 23, 2013
Editorial: Make better use of nurse practitioners


(May 23 -- By the Editorial Board)

As early as today, the California Senate may vote on a bill that would allow nurse practitioners to practice to the full extent of their education, training and certification. Senate Bill 491 would bring California in line with 17 other states that allow independent practice for nurse practitioners, without having to be supervised by a doctor.

Significantly, the University of California, which operates the largest health sciences system in the nation - providing care as well as educating future health professionals - is a strong backer of the bill.

The reality is that fewer medical students are choosing careers in primary care. Most medical students choose more lucrative specialties, such as cardiology, gastroenterology and radiology.

More significantly, nearly a third of California primary doctors do not take patients who are covered under Medi-Cal, the federal-state partnership that provides health coverage for lower-income people and which is about to expand. Independent practice would allow nurse practitioners to see Medi-Cal patients, a decision that currently is left up to supervising doctors.

Our health care system needs a healthy mix of primary care health professionals - primary care doctors with seven or eight years of postgraduate training after their four years of college, and nurse practitioners with four or five years of postgraduate training after college.

Doctors worry that allowing nurse practitioners to operate independently would cause competition with primary care doctors and increase fragmentation of care. This is overwrought. There is more than enough demand for primary care for everyone. Independent nurse practitioners would continue to work closely with doctors, either through referrals, consultation or in a collaborative practice.

The difference is that with SB 491, nurse practitioners would have their own patients, similar to doctors who are in group practices. Many would continue to work right where they are - but they would be able to accept new patients into their practice. They also would be able to avoid seeking a doctor's signature or approval for simple, straightforward medical decisions - such as prescribing an antibiotic when a patient has strep throat - or for ordering wheelchairs, hospital beds or home health care.

Nurse practitioners have graduate training that gives them the skills to take health histories, conduct physical examinations, formulate medical diagnoses, create plans for care, prescribe medications and order therapies.

The California Medical Association continues to oppose independent practice for nurse practitioners, instead pushing bills that would create more slots for hands-on medical residencies in primary care and send $15 million a year to a new medical school at the University of California, Riverside. This is necessary but not sufficient.

We need to make better use of the health professionals we have, including nurse practitioners. The Senate should pass SB 491.

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