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How to fix the doctor supply crunch

By Sally C. Pipes

Roughly 100 million Americans live in areas without enough primary care doctors. Nationwide, we’re short about 17,000 of them right now. By 2034, that number could jump to 48,000, according to the Association of American Medical Colleges.

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.

Nurse practitioners 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. Over 20 states limit or restrict the ability of nurse practitioners to engage in at least one aspect of practice for which they’re qualified. Similar restrictions exist for physician assistants.

And yet, there appears to be little to no medical 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. 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-quarters of Americans support “expanded capabilities” for nurse practitioners.

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, 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. 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 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. Yet too often, physicians trained in other countries must jump through hoops to practice in the United States.

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

Sally C. Pipes is President, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is False Premise, False Promise: The Disastrous Reality of Medicare for All (Encounter 2020). Follow her on Twitter @sallypipes. This piece originally ran in the Richmond Times-Dispatch.

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