Update Professional Practice Acts To Expand Primary Care
Californians deserve high quality primary care offered by a range of safe providers. The professionals at the heart of today’s question — physician assistants, nurse practitioners, pharmacists and optometrists — have all significantly advanced their educational, testing and certification programs over the past decade. They’ve enhanced clinical training, moved to graduate or advanced degrees, and upgraded program accreditation processes.
Other states have recognized these advances with practice acts that align with professional competence. But California’s practice acts have not kept pace.
California lags precisely when we should be ready to answer calls for appointments from millions of newly insured under the ACA. That fact alone should give us pause; we’re not meeting current need now. But even without the ACA, we have changing practice patterns (team-based care), shifting disease burdens (chronic conditions), and new technologies (telehealth and electronic health records) that call for practice law modernization.
We can no longer afford to get by on a fraction of our professional capacity. Why delay care when we have providers who could serve? Why encourage students to learn, with education funded in part by public dollars, to practice at one level and then limit their practice upon graduation? And why ignore the experience of doctors who work side by side with nurse practitioners, physicians assistants, pharmacists and optometrists as colleagues, and realize that everyone provides optimal care when everyone does what he or she knows best?
Though tempting to some, it would be ingenuous to call for more research now. I’ve been looking at the mountain of evidence regarding these professions for 20 years. The question — whether the evidence supports the assertion that they can safely provide some primary care that was historically reserved to doctors — can be answered affirmatively. Remaining opposition cannot be justified by insufficient proof.
Our country’s best academic and clinical researchers have produced premier studies confirming the safety and quality of care these professionals provide. Our country’s best communicators, from Mark Twain to Hollywood screenwriters, have weighed in on scope of practice battles more eloquently than I can.
We should already be dealing with integrating care, training teams, overhauling financing mechanisms, and incorporating technology into patient-centered care. The turf battles posed above are yesterday’s fights, ready for the history books. Of course California should update these particular practice acts and move on to imminent and even greater challenges.
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