Maryland’s Lesson: Nurse Practitioner Reform Will Increase Health Care Access

Sandra Nettina, a Maryland nurse practitioner (NP), walked into the family room of a 65-year-old woman with severe rheumatoid arthritis and osteoarthritis. It was another day at work for Sandra, and she was grateful to help a new patient.

The woman had been living exclusively in her recliner chair for over a year. Even with the help of a caregiver, she had not been able to clean herself properly. She hadn’t put on shoes or walked, and the lack of movement had caused an infection.

Sandra treated the area, prescribed an oral antibiotic, and then educated her patient on proper skin care regimen. The visit prevented a hospitalization and, most importantly, improved her patient’s hygiene, comfort, and wellbeing.

Maryland—along with 25 other states and the District of Columbia—empower NPs, like Sandra, with full practice authority, allowing them the flexibility to care for patients that would otherwise have difficulty accessing health care.

In contrast, Pennsylvania has some of the most restrictive NP scope of practice laws in the country. NPs must maintain formal relationships with at least two physicians—more of a bureaucratic technicality than meaningful collaboration. It’s an outdated restriction that severely limits the ability of NPs to practice and the types of care they can provide patients.

Pennsylvania is where Sandra had envisioned her career in medicine. She graduated from the University of Pennsylvania and took a job at Temple. Yet, when her husband got a job offer in Maryland—which had fewer practice restrictions for NPs than Pennsylvania—Sandra was all in.

Maryland then granted NPs full practice authority in 2015.

Full practice authority changed everything. Sandra now works to the full extent of her training and owns a medical practice making house calls for the elderly.

In doing so, Sandra serves her community in a way that is desperately needed nationwide. The U.S. has a shortage of health care providers that is worsening by the day. Nearly 334,000 health care providers left the workforce in 2021, and more than one-third of the dropouts were physicians.

In Pennsylvania, more than half a million people live in Health Professional Shortage Areas (HPSAs). Due to the low doctor-to-patient ratios, many travel great distances, face long wait times, and in some cases, go without care, especially in rural areas.

Sandra says she doesn’t know of any physicians that make house calls, even though older patients are often home bound and have mobility issues. Even patients with transportation are often hesitant to sit in waiting rooms during waves of COVID-19 and flu.

For many of Sandra’s patients, house calls have been their only access to health care. She estimates her practice has served 600 patients over the past five years, across two counties.

Unfortunately, too many patients in Pennsylvania don’t have the same opportunity as those in Maryland. And especially worrying are our seniors, as the commonwealth has the second-highest number of residents over 65. To alleviate chronic health care shortages, Pennsylvania lawmakers should follow their neighbor’s lead and empower NPs.

Full practice authority would allow certified and highly trained NPs to autonomously provide primary care to patients, including ordering tests, prescribing medications, and diagnosing and managing treatments.

Research has shown that full practice authority for NPs increases health care access and lowers costs, while maintaining high-quality care. A new study by the Commonwealth Foundation reveals the positive impact full practice authority would have on Pennsylvania.

Using data from neighboring Maryland, the report finds that full practice authority could eliminate close to half of Pennsylvania’s health care shortage areas and improve health care outcomes for patients.

The report also finds that full practice authority would attract more talent to Pennsylvania, increasing the number of NPs by nearly 30 percent and resulting in 1,792 more patients being seen and treated each week.

Full practice authority in Pennsylvania would be a game-changer for patients who lack adequate access to healthcare, especially the elderly and those living in rural areas.

Pennsylvania already lost Sandra to Maryland years ago. Let’s keep the NPs we still have—and encourage more to stay—by passing reform legislation that trusts them to do their jobs and improve the lives of their Pennsylvania patients.

Stephen Bloom, a former state representative, is the Vice President of the Commonwealth Foundation, Pennsylvania’s free-market think tank. Twitter: @StephenLBloom; @Liberty4pa.