Despite ample evidence that advanced practice RNs (APRNs) provide primary care that's comparable (and in some cases superior) to that of physicians, many physician groups, including the American Medical Association, have lobbied to maintain or impose strict physician supervision requirements, which limit the scope of APRNs' practice. Now the Federal Trade Commission (FTC) presents a good business case for supporting APRNs' full scope of practice.
Like other expert health policy groups, such as the Institute of Medicine, the FTC believes that APRNs play a vital role in filling gaps in access to primary care, especially for underserved and vulnerable groups and considering the drastic increase in insured patients brought about by health care reform.
More health care providers increase competition in the marketplace. Consequently, consumers benefit from lower costs, better quality care, innovative products and services, and expanded access to care.
In a new report, Policy Perspectives: Competition and the Regulation of Advanced Practice Nurses, the FTC urges state legislators to be cautious when limiting the scope of practice of APRNs. "[E]ven well-intentioned laws and regulations may impose unnecessary, unintended, or overbroad restrictions on competition, thereby depriving health care consumers of the benefits of vigorous competition. We thus urge policymakers to view competition and consumer safety as complementary objectives, and to integrate consideration of competition into their deliberations," states the report.
APRNs fit well into newer models of health care, such as retail clinics in chain drugstores and large retail stores. Such clinics provide immunizations and routine preventive screenings and treat minor infections like sore throats and ear and sinus infections. Consumers find these clinics convenient, flexible, and cost-effective. Restrictions on the scope of APRNs' practice limits access to such services and denies consumers cost-effective alternatives to less-affordable care.
Because APRNs already typically collaborate with physicians and other health care practitioners, mandatory physician supervision is unnecessary. The report is clear: laws that impose physician supervision of APRNs should be narrowly focused and based solely on research evidence showing that the health or safety of patients is at risk when APRNs independently order diagnostic tests or procedures, prescribe medications, or diagnose illnesses and medical conditions. In the absence of such evidence, such laws decrease patients' access to primary care and increase its costs.-Carol Potera