Often overlooked in the realm of healthcare and the laws that govern the field are scope of practice laws. For every healthcare profession, there is a set of services and procedures that certain occupations are legally allowed to perform. Because this list of permitted services and procedures is baked directly into the law that defines an occupation, any efforts to change an occupation's scope of practice must be done through a state’s legislature. One example of scope of practice in action would be how nurses cannot diagnose or prescribe medication. At face value, this makes sense, because a nurse lacks the education and training to independently diagnose or prescribe medication, which are two things that are never included in their scope of practice across the United States.
However, there are arguments for reform, primarily with the goal of improving access to healthcare, which is very much a relevant issue due to the national shortage of physicians. Across all physician specialties, there has been an ongoing shortage that is projected to grow worse in the coming years, with a projected shortage of 113,380 physicians across all specialties by the year 2028. Because of this, Nurse Practitioners (NPs) have come into the spotlight to alleviate part of this shortage, especially in healthcare deserts. NP scope of practice is often limited; however, broadening their scope of practice could allow NPs to help provide care to areas that lack easy access to a primary-care physician. These scope of practice changes would broadly include granting a degree of prescription authority and allowing NPs to independently diagnose and evaluate patients. Because of the lower education requirements for NPs and a larger supply of NPs relative to physicians, this type of change would create more new providers in an area.
Broadening NP scope of practice does however have some reasonable pushbacks, especially due to the education and experience differences between a physician and NP. While this concern is reasonable on paper, research and real-world outcomes have shown that these concerns don’t hold much weight. In a 2024 policy brief, the Knee Center investigated this safety question by looking at two states with different NP scope of practice and evaluating outcomes in counties along the state border. In doing so, the Center found that the policy change in Virginia had no significant impact on health outcomes compared to North Carolina. Furthermore, the expanded scope of practice also resulted in a higher density of providers in Virginia compared to North Carolina, due to NPs having a preference to work in states with a more favorable scope of practice for NPs. Because of this higher density of NPs that subsequently have more autonomy, Virginia residents overall had greater access to healthcare. for NPs. Because of this higher density of NPs that subsequently have more autonomy, Virginia residents overall had greater access to healthcare.
Similarly, to a lesser extent, pharmacists are also cited as another target for scope of practice reform. Expanding pharmacist scope of practice would allow pharmacists to test and treat minor illnesses (such as strep throat), order and interpret lab tests, and independently prescribe or renew prescriptions for medications (such as medications for HIV). These changes would take some burden off physicians and would allow physicians to focus on more severe complications, while also allowing patients to receive care faster. More importantly, these changes that broaden pharmacists' scope of practice would expand access to care in rural areas that may have a limited number of physicians and medical facilities. Simply put, pharmacies and pharmacists are more widespread than physicians, so pharmacists with a broader scope of practice can help serve patients in areas where physicians are scarce or far away.
This push to broaden pharmacists’ scope of practice has raised the same concerns about safety and quality of care that accompanied efforts to expand scope of practice for NPs. However, some papers and outcomes refute concern about safety and quality. In one scoping review that evaluated a multitude of papers relating to this topic, the findings were remarkably positive. On one hand, some papers found evidence that an expanded pharmacist scope of practice resulted in improved medicine management, adherence to medication, and greater access to care that is more urgent in the counties and jurisdictions that expanded the role of pharmacists through scope of practice. In short, getting pharmacists more involved with patient care through monitoring care and handling certain types of care has benefits for patients by improving both health outcomes and access to care.
These reforms by themselves won’t solve the issue of healthcare deserts and physician shortages; however, they are at the very least a step in the right direction towards making healthcare more accessible and tackling a broader issue. Because at the end of the day, a quick trip to a provider or having easy access to one’s prescription can be lifesaving.
Wyatt Armbrester is a Stockman Fellow at the Knee Regulatory Research Center and a senior economics major at the John Chambers College of Business & Economics at West Virginia University.