Provider Landscape Changing

As the nation gets ready to provide healthcare insurance in 2014 for millions of uninsured Americans, concerns are being raised about having adequate numbers of doctors to treat these new patients—many of whom are sick with multiple chronic diseases.

Across the nation, “scope of practice” fights are becoming commonplace. Each state’s medical licensing board defines what services different healthcare practitioners are legally authorized to provide. For example, in Washington, Vermont and some other states naturopaths practice as primary care doctors. In most  states, however, primary care services can still  be provided only by medical doctors (MDs) and doctors of osteopathy (DOs).

In the last 2 years, more than 350 scope of practice laws have been enacted nationwide, according to the National Conference of State Legislatures. Additional proposals—more than 50 since the start of 2013 are in the works in 24 states. Expanded roles have been or are being considered for nurse practitioners (NPs), physician assistants (PAs), pharmacists and optometrists.

Physician organizations are sounding the alarm that non-physician providers could jeopardize patient safety. They also maintain that these types of providers would drive up medical costs because, with less training and knowledge, they would order more tests and prescribe unnecessary drugs. In response, Beth Haney, President of the California Association of Nurse Practitioners, says “We don’t have enough providers…so we should increase access to the ones we do have.” California will be particularly hard pressed with the implementation of the Affordable Care Act’s (ACA’s) 2014 coverage provisions. Currently, only 16 of the state’s 58 counties have the federal government’s recommended supply of primary care doctors. And close to 30% of those doctors are nearing retirement.

What’s your take on the situation? Have a solution?