Almost three years after the outbreak of the Covid-19 pandemic, hospitals are still struggling with severe labor shortages. Healthcare workers face long hours and massive burnout. Earlier this year, 93% of Pittsburgh hospital workers surveyed were considering quitting the job.
Pennsylvania’s aging population has increased demand for care and exacerbated medical staff shortages. The Commonwealth has the second-highest number of residents aged over 65 amid increasingly worrying expectations of further shortages of basic services.
Nationwide, forecasts put the doctor shortage rising between 21,000 and 55,000 – further limiting access to healthcare for all patients.
Pennsylvanians are already suffering. Our Commonwealth ranks fifth nationally in the number of Medically Underserved Areas (MUA), a federal designation that measures lack of access to basic services. Of particular concern are the nearly 150 designated health worker shortage areas (HPSAs), many of which are concentrated in western Pennsylvania.
Communities like Aliquippa, North Braddock, and Hazelwood suffer from shortages of healthcare providers, and Pennsylvania’s regulations make it worse.
In Pennsylvania, Advanced Practice Registered Nurses (APRNs), like Nurse Practitioners (NPs), cannot practice to the full extent of their training. Instead, these providers must work with two physicians, both of whom can set limits on how and where they practice.
In other words, Pennsylvania law requires two physicians to sign off on an NP’s work. This means less time for patients – and there is no evidence that these rules result in better care.
Pennsylvania’s outdated regulations exclude primary care providers. Consider Lynn Heard, a Registered Nursing Practitioner (CRNP) with a Doctor of Nursing Practice (DNP) who has been providing healthcare to the family for over 20 years. The retirement of her coordinating physician forced her small practice to close in 2020. Heard has been unable to find new doctors — as many physicians today work in large hospital systems that prevent them from coordinating with outside providers.
“When my practice closed, my biggest concern was for my elderly patients,” Heard said. “They had to drive 10 or 15 miles. That might not seem like a lot, but for a 90-year-old it is.”
Her practice closed at the start of the pandemic – just when her patients needed her most. One of her former patients with melanoma still hasn’t found a new general practitioner. For Bonnie McFarland, a long-time patient of Heard’s, the practice closure made no sense.
“Why don’t we have a choice? That’s how I feel about it. My choice is Lynn, I want Lynn,” says McFarland. “I don’t want doctors who don’t take their… time. I want Lynn to spend time with me.”
To date, 24 states — including neighboring Maryland — have reformed their laws to grant NPs full authority to practice and give patients that choice.
A new Commonwealth Foundation study examines the impact of Maryland’s reform and finds that granting full practice eligibility to NPs and Certified Nurse Midwives (CNMs) would improve healthcare access and outcomes in Pennsylvania.
Specifically, the report estimates that full practice authority could increase the number of NPs by nearly 30 percent and eliminate nearly half of Pennsylvania’s geographic bottlenecks in healthcare providers.
And by comparing health care outcomes for individuals on both sides of the Pennsylvania-Maryland border, the report suggests that full license to operate in Pennsylvania would reduce the number of residents who have poor or good health conditions, including mental health, to report.
The lack of access to health care is nothing new – which is also recognized by Governor-elect Josh Shapiro. In 2023, Shapiro and state legislators must work together to increase the supply of primary care.
Empowering NPs with full practice would allow these trained frontline heroes to see and treat more patients. Knowing they have the freedom to do their job would also encourage more prospective nurses to join the provider pipeline.
In particular, research shows that NPs are more likely to move to full charter states like Maryland than to a state like Pennsylvania.
Now is the time for policymakers to take full practice authority for NPs so patients in western Pennsylvania — and across the state — have access to the quality care they need.
Elizabeth Stelle is Director of Policy Analysis at the Commonwealth Foundation.