How to fix the doctor supply crunch

To meet our country’s growing demand for care, we need to increase the supply of clinicians who can provide it. But that doesn’t mean just training more doctors. In fact, nurse practitioners and physician assistants could be delivering much more primary care but are prevented from doing so by government rules. We need to strip away this red tape that keeps patients underserved.

Nurse practitioners, for example, are highly trained. They typically hold master’s degrees and sometimes doctorates, as well as specialist training. They’re qualified to diagnose and treat patients, including prescribing medication.

Physician assistants, meanwhile, hold master’s degrees and are trained in general medicine. They likewise can diagnose and treat.

But in many cases, state-based “scope-of-practice” laws tie these professionals’ hands. Twenty-four states limit or restrict the ability of nurse practitioners to engage in at least one aspect of practice for which they’re qualified, such as prescribing certain types of medication or seeing patients without physician oversight. Similar restrictions exist for physician assistants.

And yet, there appears to be little to no medical or scientific basis for these rules. A study by researchers at Brandeis found that state regulations restricting nurse practitioners’ scope of practice did not improve quality of care. Participants in one survey of community clinics even reported higher satisfaction with nurse practitioners than with physicians.

Numerous studies show that physician assistants deliver the same or better patient outcomes as physicians.

Patients don’t benefit from scope-of-practice laws, nor do they seem to like them. More than three-fourths of Americans support “expanded capabilities” for nurse practitioners, according to a recent Morning Consult poll.

In short, these laws squeeze the supply of care for no reason. Allowing nurse practitioners to work without restriction would reduce the number of Americans living in counties with primary-care shortages from 44 million to fewer than 13 million — a drop of 70% — according to a report by UnitedHealth Group.

Fortunately, Congress is considering bipartisan legislation that would remove barriers in the Medicare and Medicaid systems that prevent nurse practitioners and other advanced-practice registered nurses from practicing to the full extent of their training.

We need similar rollbacks that apply to the private market and at the state level.

There are other ways legislators can increase the supply of care — and thereby expand access to it. During the pandemic, Congress lifted restrictions on telehealth, allowing many more patients to see providers by phone or video chat. More than eight in 10 voters with employer-provided coverage would now like to see those telehealth flexibilities extended, according to another survey by Morning Consult.

Lawmakers should also consider relaxing restrictions on physicians educated abroad. Doctors with degrees from international medical schools provide excellent care, the data show. In fact, according to a recent BMJ study, Medicare patients treated by international medical graduates had lower mortality rates than patients treated by U.S. medical school graduates.

Too often physicians trained in other countries must jump through hoops to practice in the United States. Many international medical graduates have to complete an accredited residency training program in the United States or Canada even after practicing unencumbered elsewhere. Re-licensing procedures can take four to five years.

Hurdles like these leave talent untapped. An estimated 270,000 immigrants with medical or health degrees are underemployed or unemployed in the United States, according to the Migration Policy Institute.

With our growing and aging population, there’s no way demand for health care services is going to shrink. That means we have to find ways to increase supply. Measures that deregulate the health care labor market would be a step in the right direction.