By NextBestFitSupervised transition period before independence
Require a set number of supervised hours before independent practice.
Supervised hours before independence.
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This path
Supervised transition period before independence
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Require supervised hours before independence
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Quality concerns when non-physicians practice independently
Requiring supervised practice before independence builds experience and addresses quality concerns.
What it creates or worsens
- Takes years, or money up front, before it pays off
Requiring supervised hours before independence slows the addition of independent practitioners.
- Physician shortage, especially in primary care
Requiring supervision before independent practice creates a supervision bottleneck.
5 paths soften this
Fund more residency slotsPhysician shortage, especially in primary careChosenRaise primary care pay relative to specialtiesPhysician shortage, especially in primary careChosenEasier licensing for foreign-trained physiciansPhysician shortage, especially in primary careChosenShorter training: combined undergrad/medical programsMedical education debt shapes specialty choiceRejectedFull practice authority for NPs, PAs, pharmacists, dental therapistsScope-of-practice limits waste capacityChosen
Who's affected
Who gains
- 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.
- Specialist clinicians and practices
- Physician shortage, especially in primary care: Scarcity supports incumbent specialists’ pay.
Who loses
- Residents of areas with too few health professionals
- Physician shortage, especially in primary care: Physician shortages leave them waiting for appointments.
- Doctors, nurses, and other clinicians
- Physician shortage, especially in primary care: Physician shortages contribute to burnout.
Where it has been tried
- Several U.S. states: Require 1,000 hours to several years of collaborative practice first; about half of full-practice states require none.
- United States: Among 28 U.S. states granting full practice authority to nurse practitioners, 14 require supervised transition-to-practice periods ranging from 1,040 to 4,600 hours, while 13 states and D.C. require none (2024).