pa full practice authority

Report: Access to Health Care in Pa. Stymied by Restrictive State Laws

Harrisburg, PA – A new report from the Commonwealth Foundation, Pennsylvania’s leading free-market public policy research organization, found that Pennsylvania state laws that restrict the work of advanced practice registered nurses—such as nurse practitioners and nurse midwives—limits Pennsylvanian’s access to health care professionals. The report found that states, such as Maryland, with fewer restrictions, had more advanced practice registered nurses and greater access to primary care.

The U.S. is experiencing a shortage of primary care physicians, which is expected to increase to between 21,400 and 55,200. In Pennsylvania, areas covering some or all of 20 counties and 580,000 people have been classified Health Professional Shortage Areas due to a low doctor-to-patient ratio. This shortage of primary care physicians limits access, forcing health care consumers to travel long distances, face long wait times, or go without care.

To address physician shortages, the District of Columbia and 26 states, including Maryland, have enacted laws that allow advanced practice registered nurses “full practice authority,” or the ability to practice independently of a doctor and provide comprehensive primary care to patients.

Pennsylvania has some of the most restrictive laws governing advanced practice registered nurses. For example, nurse practitioners “are required to maintain formal collaborative practice agreements with at least two physicians,” according to the report. But that’s not always easy. Lynn Heard, a nurse practitioner in Pennsylvania, described the difficulty finding doctors who can collaborate with her. “Physicians I worked with in the past now work for organizations and are unable to collaborate with someone outside of that organization,” Heard said. “It’s very hard to find an independent physician. Everyone is working for a big health care system.”

Pennsylvania nurse practitioners “may diagnose medical conditions, develop and implement treatment plans, order and perform diagnostic tests, and deliver other health care services, but the specific tasks they carry out must be specified in their collaborative practice agreement. In addition, the physician must be available for the NP in person or via telecommunications. Finally, the physician reviews the [nurse practitioners] patient records regularly.”

The Commonwealth Foundation compared laws regulating advanced practice registered nurses in Pennsylvania and Maryland and found:

  • Marylanders in border counties have better health care outcomes, including fewer residents reporting fair or poor health and fewer residents with poor mental days.
  • Before full practice authority, Maryland had more nurse practitioner density than Pennsylvania, but the gap doubled after Maryland’s reform while physician density remained constant.
  • Based on Maryland’s experience, full practice authority would increase the number of certified nurse midwives in Pennsylvania by an estimated 26.7 percent, and the number of NPs by 29.5 percent.
  • Allowing full practice authority would increase the number of patients seen by nurse practitioners per week by 1,792 patients.
  • Full practice authority could, if all nurse practitioners focus on primary care, eliminate nearly half of Pennsylvania’s geographic Health Professional Shortage Areas.

“Laws and regulations matter,” said Elizabeth Stelle, Commonwealth Foundation director of policy analysis and the report’s editor. “Maryland policies that give full practice authority to nurse practitioners and nurse midwives benefit health care consumers, providing greater access and better health care outcomes. Pennsylvania and other states can address primary care physician shortages by allowing highly trained advanced practice registered nurses to do the jobs they were trained to do.”

Read the full Commonwealth Foundation report, “How Full Practice Authority Can Increase Access and Improve Outcomes,” here.

The Commonwealth Foundation transforms free-market ideas into public policies so all Pennsylvanians can flourish.