CommunityOff the Charts

California doctors oppose expanding NP authority amid provider shortages

By: Julie Cullen

By Julie Cullen, Managing Editor, American Nurse Today

California is known as a progressive state open to innovation, but that doesn’t seem to be true when it comes to nurse practitioner (NP) independent practice. While 22 states, the District of Columbia, and federal government facilities allow NPs to practice without physician supervision, California does not.

The resistance to independent NP practice is coming primarily from the California Medical Association (CMA), which feels that a bill currently being debated in the state would take away patient protections. The impetus behind the bill is a physician shortage that’s expected to grow to a shortfall of 4,100 primary care clinicians in 10 years. The proposed bill aims to fill that gap by making it possible for NPs in the state to practice without the burden of requiring physician supervision.

As the law currently stands in California, nurses must work under the oversight of a medical or osteopathic doctor. However, the law doesn’t define what that oversight is. In fact, many nurses and patients say they have little interaction with supervising physicians. NPs say it’s difficult to find a supervising physician and when the physician moves or retires, they either must find a new one or close the practice.

The proposed bill allows NPs to work without supervision but also institutes safety measures to address some of the CMA’s concerns. Amendments to the bill include requiring that NPs pass a national certification exam and receive approval from a physician that they’re competent to practice. The bill also includes a mandatory 3-year transition period where the NP works under physician supervision before practicing independently.

The California Future Health and Workforce Commission claims that if NPs are given full practice authority by 2020, emergency department visits would decrease by 50,000, resulting in a $58 million savings per year. According to Theresa Ullrich, a family nurse practitioner and immediate past president of the California Association of Nurse Practitioners, if the bill is passed many nurses would make opening an independent practice a priority.

Source: US News  & World Report



  • Why would an NP need physician approval if they are board certified ? Certainly new physicians do not require this type of supervision or approval before they can practice independently.

  • john merritt
    July 9, 2019 9:48 pm

    Statistically speaking if memory serves Np’s in general have better outcomes than that of physicians. This is not because an NP is more educated, smarter or better than an MD, However; having been trained as a nurse and still being one, the NP will take more time to investigate, treat from a more holistic view, and generally will provide more education.

  • Margaret A Flanagan
    July 9, 2019 9:28 pm

    As a FNP I work with a company that does Medicare Advantage Home Visits.

    These are the comments I hear from the clients.
    1. The MD has a rubber band on his wrist he springs in/out in 5 mins and doesn’t even touch me.
    2. The MD usually does not explain lab values and states everything is “normal” and doesn’t want to take the time to discuss current lab results. This practice minimizes questioning that takes time.
    3. Little to no health care education is given to clients because of time constraints.
    4. During home visits, especially Diabetics & culturally sensitive populations, they do not understand their medication therapy, ADA Dietary Information, and Symptoms of PN & PAD.

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