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Autonomy for Nurse Practitioners One Answer to NC Doctor Shortage

NCNA member Deborah Varnam pens Op-Ed supporting APRNs.

March 10, 2016 - As a nurse practitioner with over 16 years of experience in primary care, I understand what it means to provide high quality health care. I have counseled young mothers to track their babies’ milestones, ordered diagnostic tests to confirm the presence of chronic disease, prescribed medications to treat conditions from arrhythmias to pneumonia, identified mental health challenges and coached hundreds of patients toward prevention and wellness.

In my clinic and countless other practices, the demand for primary care has skyrocketed. As of January, there were 145 so-called health professional shortage areas in North Carolina and 6,100 across the United States – a number that has grown by nearly 300 communities in just 18 months, according to the Department of Health and Human Service’s Health Resources and Services Administration.

There is a way to fix the primary care crisis, and nurse practitioners know the prescription. NPs have been at the forefront of providing primary health care to patients for over half a century. With more than six years of academic and clinical preparation, we assess patients, order and interpret diagnostic tests, make diagnoses and initiate and manage treatment plans – including prescribing medications. We are the health care providers of choice for millions of patients and manage 990 million patient visits per year.

More than 40 percent of states have adopted full practice authority licensure and practice laws, enabling NPs to deliver care autonomous of a physician. These states recognize that full practice authority improves access, especially in underserved urban and rural areas, streamlines care, decreases cost and protects patient choice. In the last five years alone, seven states have enacted FPA laws, and this year, states including Massachusetts, Pennsylvania and North Carolina are among those considering FPA legislation.

Despite the trend toward autonomous practice for NPs, states like North Carolina lag behind. Physician organizations continue to increase efforts to oppose patients receiving full and direct access to NPs, despite the fact that every major study on NP care – more than 100 – has shown that NPs’ patient health outcomes are as good or better than other providers. The impact on patient care is undeniable: Of the 10 states with the greatest number of health-provider shortage areas, nine are in reduced-practice or restricted-practice authority states. North Carolina ranks 16 on the list of shortage areas.

Access to high-quality primary care is key to improving patient outcomes. Research published by the University of Missouri in 2014 found that FPA states have lower hospitalization rates and improved health outcomes for Medicare and Medicaid patients. And the United Health Foundation’s 2015 ranking of healthiest states in America included eight FPA states among the top 10.

If North Carolina “builds” full practice authority, nurse practitioners will come. In the five years since Arizona enacted FPA, the number of NPs increased by 52 percent, and significantly the number of NPs in rural counties increased by 73 percent. Meanwhile, neighboring Nevada has seen a more than 20 percent increase in its NPs since changing its law in 2013.

A majority of patients want greater access to NP services, and NPs have the skills and training to meet North Carolina and our nation’s growing health care needs. Removing scope of practice barriers will ensure patients access to timely, high-quality, patient-centered primary health care. NPs are the right prescription to addressing North Carolina’s and America’s primary care crisis.

Deborah C. Varnam is the Region 4 director for the American Association of Nurse Practitioners and the owner of Varnam Family Wellness Center in Shallotte.

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