In the span of three months, Columbia County, a small rural community of about 64,000 people in northeastern Pennsylvania, lost five medical facilities, including an eleven-bed hospital. If not for two nurses, tens of thousands of residents would lack primary care.

“We saw a void,” said Dallas Riley, a certified registered nurse practitioner (NP), who partnered with Michelle Hall, also an NP, to open Hall & Riley Comprehensive Healthcare LLC.

This void is a persistent problem in rural Pennsylvania. And if lawmakers grant more autonomy to dedicated nurses like Riley and Hall, they could quickly and cost-effectively fill that void.

Since 2005, Pennsylvania has lost six rural hospitals, with several more reducing services or on the verge of closure. Kaiser Family Foundation research reveals more than 600,000 people live in Pennsylvania’s 153 designated Health Professional Shortage Areas. To resolve this, Pennsylvania needs 116 new primary care providers to establish practices in these areas.

There is good news and bad news about these shortages.

First, the good news: The number of primary care providers is growing nationally, and for NPs, it more than doubled from 2010 to 2017. NPs are registered nurses with a graduate degree in nursing who complete national board exams and hold state licenses. In Pennsylvania, they receive certification and answer to the commonwealth’s Board of Nursing.

Currently, 27 states and the District of Columbia allow NPs to practice fully, meaning they can diagnose patients, prescribe medicine, and treat people without physician oversight. In states with full practice authority, NPs have more time to meet patients’ unmet needs in underserved communities.

Now, the bad news: Pennsylvania isn’t one of those states.

Pennsylvania is a reduced practice state where NPs must sign a collaborative practice agreement with not one, but two physicians. Instead of helping their patients, NPs and doctors lose valuable time drafting and managing these agreements. We want our health professionals providing health care, not doing paperwork.

Doctors overseeing NPs equals less time spent with patients. If NPs had greater autonomy, all, especially patients, would benefit from the reduced paperwork and bureaucracy. Granting Pennsylvania’s NPs full practice authority would increase direct patient care, amounting to an additional week’s access (109 patients) per NP each year.

Full practice authority may seem like a technical issue; however, it’s not hyperbole to say that freeing NPs from bureaucratic rules saves lives. Research by Benjamin McMichael in the Journal of Public Economics found that relaxing NP scope-of-practice laws reduced care-amenable deaths by 12 per 100,000 individuals. And the larger reductions were in rural areas.

Likewise, research in the Journal of Rural Health shows that diabetic patients received better, less costly care after states reformed their NP laws. The effect was more significant for rural patients because additional care-provision time makes a greater difference in areas lacking access.

While many providers tend to move to urban areas with many patients, NPs are more likely to work in rural and underserved communities. Recent research shows that when rural hospitals close, NPs are more likely than physicians to stay in the rural community by taking positions in urgent care centers, free-standing birth centers, and outpatient centers.

Most initiatives to improve rural health mean more government funding; in contrast, changing scope-of-practice laws doesn’t require spending more. Instead, this reform allows NPs to work independently and saves the health care system money. NPs are less costly than doctors, and increased primary care saves money by detecting and treating medical problems early.

Prominent national organizations, including the National Governors Association and AARP, have endorsed independent practice for NPs.

Addressing this shortage becomes increasingly urgent as Pennsylvanians age. The commonwealth’s share of elder residents, ages 65 and older, will almost double by 2030. With this older population comes increased demands for long-term care and medical services, further squeezing the commonwealth’s already beleaguered health care system.

Pennsylvanians, primarily those living in rural areas, suffer from a primary health care provider shortage caused by the commonwealth’s excessively restrictive medical regulations. Whether Pennsylvania will enjoy a healthier future depends critically on what state legislators do. Giving NPs full practice authority would increase the availability of primary health care in our state — all without costing the taxpayers a penny.

Dr. David Mitchell is the Distinguished Professor of Political Economy and the Director of the Institute for the Study of Political Economy at Ball State University.

One thought on “David Mitchell: Nurse practitioners can solve rural health care shortages”

  1. Nurse Practitioners are no replacement for Dr.s. they don’t know what they are talking about and misdiagnose people, giving poorly informed prescriptions.

    It is a dangerous scenario to encourage an education and professional qualification level to think they can act like Dr.s, rather they are worse than Nurses who acknowledge the limitation of their roles.

    Please stop.

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