Several months ago, I received a call from my OB-GYN. They cancelled my upcoming appointment yet again, offering a new appointment in two weeks. It was their third cancellation in a row, and I had already not been seen in over a month.
Sensing my frustration, the secretary explained: due to a personal emergency, the doctor would not be in the office until then. I pressed, surely their nurse practitioner could perform a simple checkup to screen for serious pregnancy complications such as preeclampsia or gestational diabetes (that often present without any obvious symptoms) and use a doppler to check on my baby’s heartbeat.
The secretary told me that none of their nurses would be able to do that, as they would not know how to interpret the results.
Nurse practitioners are highly trained medical workers who have at least obtained a master’s degree and clinical training. The secretary was either unaware that the nurse practitioner would be fully capable of a simple checkup or was bluffing. I found a new doctor’s office.
My slight inconvenience exemplifies why allowing well-qualified nurse practitioners to diagnose, treat, and write prescriptions would help ease California’s doctor shortage. Unfortunately, California is one of 22 states that still require physician oversight of nurse practitioners.
A study by California Health Care Foundation (CHCF) found that California only had between 35 and 49 primary care doctors per 100,000 individuals enrolled in Medi-Cal, which is less than half of the amount of doctors recommended by the federal government (85 to 105 per 100,000). Medi-Cal covers one in three Californians.
But the CHCF study only paints part of the picture. Because Medi-Cal enrollment is public data and much easier to find, the study does not delve into whether individuals who use private healthcare receive adequate access to doctors. The answer is most likely no.
According to a June study by the Association of American Medical Colleges, the United States will face a shortage of 124,000 doctors by 2034.
And amid the pandemic, the doctor shortage has only exacerbated. As the demand for health care intensified during the crisis, California still resisted easing restrictions on allowing nurse practitioners their necessary independence.
Although solving California’s doctor shortage requires several solutions, one key solution would be to allow nurse practitioners to practice the full range of skills for which they trained. California currently has 29,766 active nurse practitioners, and 26,951 of those even have the special credentialing that allows them to prescribe drugs and devices to patients.
Rural areas in California and the quickly growing Inland Empire are hit hardest by the doctor shortage. Nurse practitioners cannot practice without a doctor’s oversight, and a doctor cannot oversee more than four nurse practitioners at a time. So, in areas such as Central Valley or the quickly growing Inland Empire with significantly fewer doctors available to see patients, there is potentially a surplus of trained nurses who are unable to assist the strain.
In 2020, Governor Newsom signed AB 890 (Wood) which gave nurse practitioners full practice authority beginning in 2023. Among many other restrictions, the bill requires a “transition to practice” (TTP) period of three years of oversight from a doctor.
Initially, the bill seemed to be good news for nurse practitioners. But the bill burdens nurse practitioners with more bureaucratic red tape and unnecessary costs. On the issue, the American Association of Nurse Practitioners (AANP) wrote:
“No other western state creates such practice barriers for NPs or patients seeking NP-delivered care. California’s so-called ‘solution’, the flawed AB890, would establish a cascading set of new restrictions on NP practice that would maintain California’s position among the most heavily regulated and restrictive in the nation.”
As California’s doctor shortage exacerbates, Sacramento legislators must properly deregulate so that trained nurse practitioners have the freedom to practice independently.
McKenzie Richards is a health care program associate at the Pacific Research Institute.
