By NextBestFitFull practice authority for NPs, PAs, pharmacists, dental therapists
Let each profession practice to the full extent of its training.
Fastest way to add capacity before demand rises.
To review: Physician groups raise quality concerns; paired with outcome monitoring.
Review ledgerHow this path connects
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Grant full practice authority to NPs, PAs, pharmacists, dental therapists nationally
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
- Scope-of-practice limits waste capacity
Allowing each profession to practice to the full extent of its training adds capacity quickly at lower cost.
- Physician shortage, especially in primary care
Letting other professions use their full training adds care capacity quickly.
- Health professional shortage areas
Allowing professions to use their full training adds care capacity quickly at lower cost.
- Longer waits if demand grows faster than capacity
Expanding practice to the full extent of training quickly adds capacity for care.
- Quality concerns when non-physicians practice independently
Expanding professions' practice raises quality concerns among physician groups, and some studies find more prescribing and referrals.
Who's affected
- Residents of areas with too few health professionals
- Scope-of-practice limits waste capacity: Practice limits prevent trained professionals from filling care gaps.
- Physician shortage, especially in primary care: Physician shortages leave them waiting for appointments.
- Health professional shortage areas: Clinician shortages limit primary and mental health care access.
- Doctors, nurses, and other clinicians
- Physician shortage, especially in primary care: Physician shortages contribute to burnout.
- Rural residents
- Health professional shortage areas: Clinician shortages limit primary and mental health care access.
- Low- and middle-income households
- Health professional shortage areas: Clinician shortages limit primary and mental health care access.
- People with employer coverage
- Longer waits if demand grows faster than capacity: They are seen fastest today and would share one queue with everyone.
- People with ongoing or specialist care needs
- Longer waits if demand grows faster than capacity: They need specialists and procedures most often.
- Doctors, nurses, and other clinicians
- Scope-of-practice limits waste capacity: Physicians benefit from a protected market.
- Specialist clinicians and practices
- Physician shortage, especially in primary care: Scarcity supports incumbent specialists’ pay.
- People with ongoing or specialist care needs
- Quality concerns when non-physicians practice independently: Expanded independent practice may expose them to missed diagnoses or over-prescribing.
Where it has been tried
- About half of U.S. states: Grant NPs full practice authority.
- United States: As of March 2023, 27 U.S. states granted nurse practitioners full, independent practice authority.