Guest Column | October 13, 2020

Shortage Of Primary Care Providers And Access To Care Driving Nurse Practitioner Scope Of Practice Changes

By Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, Chief Nurse of Wolters Kluwer’s Health Learning, Research & Practice business

450 x 300 patient doctor patient recruitment

There is a shortage of primary care providers (physicians, nurse practitioners, physician assistants) in the U.S. In California, the shortage has been troublesome, especially in rural areas. The government recommends 60-80 primary care providers per 100,000 population; in California, the number is down to 50 in urban areas and even lower in rural areas. In addition, 2.5 million Californians who previously were uninsured, have gained insurance through the Affordable Care Act and are now eligible for coverage.

Physicians are not going into family practice due to low pay and long hours; they gravitate to salaried positions and to medical specialties where the pay is better. With the cost of medical education, they simply cannot afford to pay their loans and live while working in family practice.

There are 25,892 nurse practitioners in California; around 18,000 are actively practicing. Nurse practitioners have worked under a supervision agreement with physicians. Because of the restricted practice, nurse practitioners have been leaving California to move to other states where they can practice independently or with collaboration which has also contributed to the shortage of primary care providers.

California Assembly Bill 890 gives NP’s independent practice and will increase access to care

Assembly Bill 890 was signed into Law by Governor Gavin Newsome. This allows nurse practitioners to work independently without physician supervision. The law goes into effect in 2021 and by 2023, nurse practitioners will be able to practice independently after a 3-year transition period where they will be under the supervision of a physician. The law also moves oversight of the scope of practice for nurse practitioners to the Board of Nursing. This law will hopefully keep more nurse practitioners in California to provide access to care for all in need.

NP’s provide high quality, effective and safe care

Without a doubt, COVID-19 has brought to the forefront the fractures within the healthcare system. Access to healthcare is one of the social determinants of health and is key to eliminate health inequities and care variability. By providing nurse practitioners with the ability to practice independently more patients, especially those in rural areas, will have access to care.

There are 28 states in the U.S. that allow for independent practice for nurse practitioners including diagnosing, ordering diagnostic studies, and developing and implementing a treatment plan including prescribing medications. The other states require either a supervision or collaborative agreement for nurse practitioners to practice. Research has demonstrated that care rendered by nurse practitioners is safe, effective, quality care and this has been endorsed by the Institutes of Medicine. While physicians may worry that nurse practitioners won’t consult and collaborate with physicians when appropriate, this is not the case. The highest quality care is delivered by an interdisciplinary team. While education for physicians and nurse practitioners is different, the quality of care is the same.

The law gives Californians access to more healthcare providers than ever before. Many states who currently have collaborative and supervision requirements to the NP scope of practice are undergoing the same journey to change state law so that NP’s can practice independently. Without a doubt, COVID-19 has helped push this endeavor along. Many states relaxed their supervision and collaboration agreement requirements to manage the surge of patients requiring care and quality of care did not suffer.


Assembly Bill 890. California.

Phillips, S. (2020). 32nd Annual APRN Legislative Update: Improving Access to High Quality, Safe, and Effective Care. The Nurse Practitioner; 45(1); 28-55.