“The major motivation in this opposition is kind of a turf war,” says Dale Ann Dorsey, a nurse practitioner who runs her own women’s health clinic in Scottsdale, Arizona.
Arizona is one of 18 states that allows nurse practitioners to run independent primary care practices, with full prescribing privileges, and without the oversight of a licensed physician. Earlier this year, nurse practitioners in California pushed to liberalize scope-of-practice rules in the Golden State, only to be stopped dead in their tracks by the powerful California Medical Association (CMA), which poured more than $1 million into lobbying efforts in the first half of 2013, when the legislation was under consideration.
“[Nurse practitioners‘] training is very limited compared to physicians,” says Paul Phinney, a California pediatrician and former CMA president. “They lack a certain kind of experience that I believe is very important to the safety of patients and the quality of medical care that they’re providing.”
He has a point. Physicians are required to obtain far more education and clinical experience than are nurse practitioners. But there’s little to no evidence showing that, when it comes to primary care, all of that extra education makes any difference in patient health outcomes. A 2012 Health Affairs survey of the medical literature found no difference in patient health between the two groups and even found a slightly higher satisfaction rate among patients of nurse practitioners.
So if outcomes are similar, and patients are satisfied, why are states like California hesitant to let more nurses open their own practices, especially when groups like the Association of American Medical Colleges are expecting a doctor shortage time-bomb to detonate in the near future due to the aging population? Reason policy analyst Adam Summers says that concern for the public good is a secondary consideration at best in this case.
“Licensing laws are almost always sold as being in the public interest,” says Summers. “But in reality all they do is drive up prices and reduce competition, which reduces the incentive to provide good services to the consumer.”