Twenty-two states, Washington D.C. and two U.S. territories allow advanced registered nurse practitioners to work independently of physicians.
And after years of debate, lawmakers this spring will again grapple with whether to take the leap and give the additional authority in Florida.
The House Health Care Quality Subcommittee on Wednesday heard the pros and cons of allowing advanced registered nurse practitioners to operate independently of physicians and whether it would increase access to care.
Tay Kopanos, vice president of state government affairs for the American Association of Nurse Practitioners, said states are turning to a number of solutions to increase access to care, including building more medical schools, increasing the number of medical residencies, establishing repayment programs for providers willing to work in underserved areas and investing in telehealth initiatives.
“As states are moving forward, they are realizing it’s not going to be one single silver bullet that solves this but it’s really going to be all-of-the-above solutions that are needed,” she said. “And out of all the solutions that are on the table, rightsizing licensure laws is the only solution that is at no added cost to the state, no delay in the benefit to the consumer and the state, and it is the only solution that has a track record of 40 years of success in other states around the country.”
The Republican-led state House has refused to expand Medicaid under the federal Affordable Care Act. But in lieu of expanding Medicaid, House Speaker Jose Oliva, R-Miami Lakes, has made it a priority to lower health-care costs by eliminating what he says are unnecessary regulations.
Oliva maintains that Florida is “behind the curve” because it doesn’t allow nurses “to practice to the extent of their training.” But taking steps such as granting more authority to advanced registered nurse practitioners has run into opposition from doctors.
The Senate in recent years has been more reluctant than the House to rewrite rules and regulations surrounding health-care practitioners and facilities. Senate President Bill Galvano, R-Bradenton, has said that he wants to “make sure we are listening to our doctors in terms of what they see in the system.”
The 2019 legislative session will start March 5.
Advanced registered nurse practitioners have advanced degrees and can work in primary-care environments delivering basic care or in surgical settings administering anesthesia.
Florida has 29,100 advanced registered nurse practitioners who have active licenses, according to the latest available data from the state Department of Health.
That figure includes certified registered nurse anesthetists, nurse practitioners, certified nurse midwives and clinical nurse specialists.
Florida law requires that so-called ARNPs practice under the supervision of medical doctors, osteopathic physicians or dentists. Manning Hanline, a Pensacola-based internist, said that allowing ARNPs to practice independently wouldn’t increase access to care.
“We believe that the patients will receive minimal, if any, benefit from this independent practice. And, furthermore, we think that there is a risk that patients may be required to see nurse practitioners rather than physicians,” he said. “We believe that patients should have the right to access to care by a physician. We have the highest regard for the nurse practitioners. I’ve worked with them for many years, but their training is, in fact, less than primary-care physicians. And they should not be viewed as equivalent to physicians.”
Moreover, Hanline said that allowing the change wouldn’t mean nurse practitioners would go to medically underserved or rural areas. He said nurse practitioners in Pensacola cluster around large doctor groups and sub-specialists because that’s how they get paid.
“I would do the same thing,” he said adding, “I have yet to have a nurse practitioner come to my office, knock on the door and and say, ‘Dr. Hanline, I have this burning desire to go out to … some rural area or even in the inner city, and serve the population there. Will you be my supervising physician?’ It hasn’t happened. I think the nurse practitioners will be just like doctors, they will follow the pattern of reimbursement.”
But Kopanos countered, saying that in other states, independent nurse practitioners head to rural or underserved areas.
“States with more favorable licensure laws have more nurse practitioners working in rural areas,” she said.