One of the great blessings of technological advancement is that many tasks that once required expertise have become routine. While this change is frequently recognized in industries like manufacturing, fewer people consider the implications for heavily regulated industries like healthcare. Despite technological advancements, regulations restrict healthcare providers from providing care to the full extent of their capabilities.
The United States is facing a worsening shortage of doctors, particularly in rural areas. Many states restrict non-physician professionals’ ability to provide basic care instead of recognizing how technology has made many tasks routine.
State scope of practice (SOP) laws define what each healthcare profession can do. Intended to protect patients by being overly restrictive, these regulations can drive healthcare costs up and reduce access. Services such as basic diagnosis and prescriptions, which once required a doctor, can now be reliably done by other trained healthcare professionals, expanding healthcare access for patients.
Tennessee provides a good example. A recent law expanded prescription authority for pharmacists to prescribe medicine for the flu, COVID-19, hormonal contraception, naloxone, HIV post-exposure prophylaxis, and epinephrine autoinjectors. In some cases, speed is critical: the National Institutes of Health notes that “every hour counts” when providing post-exposure HIV treatment. By bringing care closer to the patient, lives can be saved.
Tennessee is not the only good example. New York is considering a bill that would allow nurse practitioners greater independence by reducing the red tape on collaborative medical practices. This could make medical care far more accessible, especially in areas where doctors are in short supply.
Unfortunately, not all states’ proposals are as inspiring. Mississippi recently proposed a bill allowing certified registered nurse practitioners to practice independently — but only after 10,000 clinical hours. That is the equivalent of spending 40 hours a week, every week, for almost five years. In reality, only half of a nurse’s shift will likely be spent in clinical hours, meaning it could take a decade to qualify, assuming the nurse never takes a vacation or gets sick during that time. The average career length for a nurse is only nine years, and more than half of nurses leave the career entirely within five years. Few nurses would qualify for Mississippi’s program, making it unlikely to increase patients’ access to healthcare in the state.
Fortunately, the requirement of 10,000 hours was never implemented. Unfortunately, that is because the bill died in committee, and no reform has passed in Mississippi to ease the path for nurses to practice independently.
By contrast, South Carolina offers a better path forward. A proposed bill in that state would allow advanced practice registered nurses to practice independently after a far more reasonable restriction of 2,000 clinical hours.
Mississippi isn’t the only state setting the bar too high. Arizona is considering allowing physician assistants to practice without direct supervision after 6,000 clinical hours. While the intent is good, it faces the same problem as Mississippi’s prohibitive requirements. Again, South Carolina provides a better example in its proposed legislation to expand physician assistants’ SOP after 2,000 clinical hours.
Reform only matters if it is realistic. If the typical provider can’t meet the requirements within their career span, it’s all for show, and patients are no better off.
If lawmakers are serious about improving access to care, they need to prioritize reforms that increase access to safe, reliable care. That means trusting the expertise of nurse practitioners, physician assistants and pharmacists, and letting them take on responsibilities they’ve already proven they can handle. Millions of Americans struggle to access healthcare. Legislators should act swiftly to pass practical SOP reforms that bring routine care into pharmacies, nurse-led clinics, and underserved communities. We have talented professionals. It’s time to find the political will to bring them together.
