Sounding the alarm on independent practice of nurse practitioners

By Pennsylvania Medical Society President, Kristen Sandel, MD

This legislative session, nurse practitioner groups have been circulating state Senate Bill 25, which would allow certified registered nurse practitioners, or CRNPs, to practice independently in Pennsylvania.

Current state law requires CRNPs to have a collaborative agreement with a physician to oversee a patient’s care. These agreements ensure the immediate availability of physician intervention in the management of a patient’s care should anything arise that is beyond the scope of a nurse practitioner’s training.

Nurse practitioners want to remove that agreement.

As president of the Pennsylvania Medical Society and a working emergency medicine physician living in Berks County and working in Lancaster County, I can tell you that the need for physician oversight is the best approach for quality health care for Pennsylvania patients.

The main driving point for the argument to expand non-physician roles is that it will expand access to health care in rural areas of Pennsylvania. However, research from the American Medical Association mapped out locations of primary care physicians and nurse practitioners in rural, western states and showed they tend to practice in the same areas of the state as physicians, regardless of scope of practice laws.

There is also strong evidence that when nurse practitioners and physician assistants practice without any physician involvement, it results in worse patient outcomes while increasing costs due to overprescribing and overutilization of diagnostic imaging and other services.

In a 2022 study by the National Bureau of Economic Research, an analysis of care provided of nurse practitioners practicing independently was conducted of emergency departments within the Veterans Administration. It found that nurse practitioners used more resources than physicians including x-rays, CT scans, and formal consults. The study found that nurse practitioners increased the cost of emergency care by 7% — about $66 per patient compared with physicians.

The study also estimated that continuing the current staffing allocation of nurse practitioners in the emergency department would result in a net cost of $74 million per year compared with staffing the ED with only physicians.

I do not want to diminish the importance of nurse practitioners as members of the health care team, but this study highlights they are not a replacement for a physician. There is no need to expand scope of practice laws only to put the patients of Pennsylvania at risk. Physicians value the importance of nurse practitioners as an integral part of the overall health care team.

Patient care in Pennsylvania is most effective when delivered through team-based care. The Pennsylvania Medical Society will continue to fight for quality patient care in our state.