Vigorous Debate Over a Proposal to Expand the Scope of Practice for NPs at the VA

With a number of studies showing that nurse practitioners provide care comparable to that of physicians at a much lower cost, expanding the scope of practice of these professionals to allow them to provide healthcare without the physician oversight seems like an obvious thing to do. So obvious, in fact, that the Veterans Affairs health system is proposing to do just that.

This proposal faces vigorous opposition from physicians. In fact, the open comment period for this proposal received 174,411 responses. This number represents twice as many responses ever received for a federal proposal.

The American Association of Family Physicians sharply criticized the VA’s proposal claiming that it would put patients at risk. The organization represents 125,500 primary care physicians and medical students.

Ironically, primary care physicians are in short supply, which has particularly severe effects in underserved communities such as those with a disproportionate number of low-income and/or rural residents. Allowing NPs to practice at the full scope of their education has helped to alleviate this shortage in the states that have eliminated such scope of practice restrictions. In fact, half of the states in the US now allow NPs to practice independently.

Predictions suggest that this critical lack of family physicians will only worsen over the coming years. One analysis that suggests this may be the case is a 2015 study from the Henry J. Kaiser Family Foundation. The federal government itself predicts a shortage of 20,400 primary care physicians in 2020. In contrast, data from the federal government suggests that the number of primary care NPs will increase by 30% between 2010 and 2020.

The combination of lower cost, increased access to care, and the wishes of consumers make a very strong case for relaxing the regulations on NPs. It appears that the VA is on the right track to increase the availability of quality healthcare for veterans in this country.