"The major motivation in this opposition is kind of a turf war," says Dale Ann Dorsey, a nurse practitioner (NP) who runs her own women's health clinic in Scottsdale, Arizona.
A nurse practitioner is a registered nurse (RN) who has pursued extra clinical training and a master's degree and is able to practice medicine beyond the scope of what a regular RN can. How far beyond that scope NPs should be allowed to go is a question facing legislators across the country.
Arizona is one of 18 states that allow nurse practitioners to run independent primary care practices, with full prescribing privileges, and without the oversight of a licensed physician. Earlier this year, nurse practitioners in California pushed to liberalize scope-of-practice rules in the Golden State, only to be stopped dead in their tracks by the powerful California Medical Association (CMA), which poured more than $1 million into lobbying efforts in the first half of 2013 to defeat the legislation.
"[Nurse practitioners'] training is very limited compared to physicians," says Paul Phinney, a California pediatrician and former CMA president. "They lack a certain kind of experience that I believe is very important to the safety of patients and the quality of medical care that they're providing."
He has a point. Physicians are required to obtain far more education and clinical experience than are nurse practitioners. But there's little to no evidence showing that, when it comes to primary care, all of that extra education makes any difference in the health outcomes of patients. A 2012 Health Affairs survey of the medical literature found no difference in patient health between groups treated by doctors and by nurse practitioners. The survey did find a slightly higher satisfaction rate among patients of nurse practitioners.
So if outcomes are similar, and patients are satisfied, why are states such as California hesitant to let more nurses open their own practices? The question is especially pressing since groups such as the Association of American Medical Colleges are expecting a severe doctor shortage in the near future due to the aging population. Reason Foundation analyst Adam Summers says that concern for the public good is a secondary consideration at best in this case.
"Licensing laws are almost always sold as being in the public interest," says Summers. "But in reality all they do is drive up prices and reduce competition, which reduces the incentive to provide good services to the consumer."
Watch the video to learn more about the nurse practitioners' struggle for clinical independence—a fight that just make health care cheaper and more available.
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Approximately 5 minutes. Produced by Zach Weissmueller. Shot by Tracy Oppenheimer and Weissmueller. Graphics by William Neff.