Riches by Regulation: Communities’ Most Trusted Healthcare Workforce Needlessly Overburdened

For nearly 20 years, the nursing profession has resided atop Gallup’s most trusted professionals list. Hardly anyone would dispute the high ratings, and most are contented to think that number means all is well with those operating in the profession. It’s not. Nurse practitioners (NPs) in particular, the unsung heroes of America’s healthcare workforce, routinely face unnecessary barriers to carrying out their jobs by one of the most notoriously cumbersome of all government functions: regulation.

In 28 states these outdated regulations have exacerbated the healthcare provider shortage and needlessly put patients at a severe disadvantage when it comes to accessing care. The public is supportive of reasonable, transparent, and effective regulation of the health care industry and its workforce, especially when it comes to patient safety, but they’re not for the disgusting predatory nature of special interest groups asserting influence and favoring profits at the expense of patients.

These physician-backed groups seek only to protect a too often overlooked or dismissed profit schemes whereby doctors line their pockets under the letter of the law without treating patients.

And though we’re still closer to the 2018 midterms than we are to Election Day 2020, lawmakers at the state and federal levels axiomatically fail to reign-in these practices and enact right-sized laws which keep pace with patient demand and technological advancements.

Increasingly, physician groups backed by organized medicine needlessly attack NPs with thinly veiled fearmongering tactics intended to sow distrust with patients. In the name of unarticulated “patient protection” they seek to limit the scope of practice for NPs and others by working against legislation that would empower NPs to provide care to the fullest extent of their education, training, and licensure.

In the majority of states, these groups aggressively lobby lawmakers to ensure profit mechanisms called collaborative agreements maintain legal frameworks by which physicians profit from NPs’ practices, even though the physicians may never actually see, treat, or even meet the patients NPs provide care for.

Patients should not have to pay for the services of a provider they never see – and government shouldn’t be in the business of allowing outdated regulations to negatively impact patients’ pocketbooks and diminish their ability to access affordable primary care services.

With over a quarter million NPs licensed to practice across the country, patients and consequently markets have responded to the quality and convenience of care NPs provide. And amid massive provider shortages, NPs have stepped up to bridge the gap with an unparalleled commitment to go where the need is greatest. The same cannot be said for their physician colleagues.

When physicians increasingly favor more comfortable and specialized settings, NPs like those operating the Health Wagon in rural Appalachia are finding ways to provide families with primary care services despite well-funded, anticompetitive, and ultimately anti-patient, special interest groups working against their ability to treat patients.

They’re but one of thousands of examples where NPs have risen to the occasion and transformed America’s health care workforce for the better. The good news is that 22 states, the nation’s capital and two U.S. territories recognize the value of NPs and have modernized their scope of practice laws allowing NPs to provide affordable and high-quality health care for all patients from rural to urban areas. In the short term, NPs may very well be the panacea to primary care we’ve been looking for.

In fact, eight of the top ten healthiest states have eliminated outdated regulations on NPs while the least healthy states have not yet embraced a favorable and more effective regulatory environment.

The Trump Administration also acknowledges the negative impact regulations of this kind have on the fairness and competitiveness of health care markets. Three agencies recently published a report describing how the removal of these regulatory barriers, among other recommendations, can make an immediate impact on increasing access to preventative and primary care.

At a time when the ideological struggle for the illusive, and so far unrealistic, comprehensive overhaul of America’s health care system has led to perpetual gridlock and inaction, the remaining 28 states with outdated regulations on NPs should heed the facts and undeniable successes of neighboring states and immediately move to modernize their scope of practice laws.

A projected surge in the number of NPs entering the workforce, high demand for the most accessible, affordable, and convenient providers will drive patients to further question if their representatives have enacted the obvious and meaningful reforms allowing them to see the provider of their choice – or if they’re more committed to leveraging the heavy hand of government to stymie intensely competitive health care markets and maintaining a deceptive profit scheme albeit government-endorsed.

Nurse practitioners (NPs) in particular, the unsung heroes of America’s healthcare workforce...

LOL. Some of the most under trained and over-privileged health care professionals I've ever worked with.

Physician's assistants (PAs) tend to be much better trained (in my experience).

Years ago A nurse practitioner misdiagnosed my mom’s heart attack as “probably a pulled chest muscle”. A week later she had a massive heart attack-doc told her she should be six feet under. Long story but because she was told it’s not a heart attack she didn’t seek help until she almost died.

Last week another nurse practitioner spent about 60 seconds with her and told her she just had a virus, nothing can be done. Mom was so miserable she followed up two days later with her doctor: her eardrum was ruptured from a “raging” ear infection. Two rounds of antibiotics still haven’t helped, she spent two and a half hours with an ENT to figure out what’s going on. Obviously a severe infection but the nurse practitioner couldn’t even recognize an ear infection.

With urgent care in their system you see a nurse practitioner, not a doctor. They misdiagnose often.

Physician's assistants (PAs) tend to be much better trained (in my experience).

That's mostly the case in the organization in which I work, although there are a couple of standout NPs.

One thing I've found a bit annoying, though, are the NPs who go back and get a PhD in nursing. Then they want to be called "Doctor".

It's not their fault that the term is used for both MD/DOs and PhDs, but in a health care setting, when someone is called "Doctor", and MD/DO is assumed by the patients - not a PhD in nursing, however valuable that may be. Seems disingenuous to me, but I'm not a clinician so it's not my circus.

In a hospital setting, in practice, the only reference of a 'doctor' is made to a physician.

Decades of degree creep has produced 'doctorate' level programs in Pharmacy, Nursing, Physical Therapy and the like. Only a small percentage of the most arrogant practitioners want others to refer to them as 'Doctor'.

I've met a few of these idiots and my response is to ignore them.

“Being in the business, my best advice, when something doesn’t seem right, is to get a second (or third) opinion.”

“Find another doctor. Get another test.” Frank Zappa about 2 weeks before he died from prostate cancer.

Well played.

I still miss Frank. He was a true musical genius and he always put on an incredible show.

Enjoy your day.

I worked with Nurse Practioners and Physician's Assistants at a large,well known hospital. I was in Aministration so I have no formal medical training but my opinion is that an NP or a PA would be valuable working in rural or "under served" areas but in the setting where I worked I can't see a need for them other than for cost cutting.

Regardless of how minor my complaint might be I want an MD who was trained in the civilized world (US,Western and Central Europe,etc) examining me.

For example...we were in Dubai a few years ago.For those unfamiliar with Dubai it's a large,modern city that's right next door to Saudi Arabia.While there my eyes began to bother me like crazy...I was in a bad state.But rather than consult any of the doctors there I called my Opthalmologist's office in Boston and was told that I probably had "dry eye" due to the fact that the humidity there is usually around 10%.Got the drops she recommended and was cured.

No way was I gonna go to a Dubai clinic no matter how modern it looked (99% of Dubai's buildings are less than 10 years old).

“Physician’s assistants (PAs) tend to be much better trained (in my experience).”

I received certification as a PA in 1975. We were trained in medicine, NOT nursing. When we proved that mid-level providers were a successful concept the nursing boards came up with the idea of “nurse practitioners” who are trained in nursing, NOT medicine. Therein lies the main difference.

Right from the start the nursing boards wanted to insulate their “practitioners” from association with physicians. PA’s embraced working in collaboration with physicians.

Over my 43 year career I have met some outstanding NP’s and some lousy PA’s. I’ve also met some outstanding and some lousy physicians. On the whole, I think PA’s are better trained to think in medical terms than NP’s.

I have worked almost exclusively in underserved, rural areas. I prefer this and believe it is the perfect place for PA’s and experienced NP’s. I dislike working in cities because that is where I am more likely to deal with leftards and SJW’s. No thanks.

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