Contrasting Efforts to Solve Physician Shortage Dilemma in Underserved Areas

Two new pieces of legislation, a federal bill in the US Senate and a state bill in Pennsylvania, would attempt to alleviate the physician shortages in underserved areas through different means: one awards more authority to advanced practice registered nurses (APRNs) and the other would allow more foreign physicians to stay in America’s needy communities to practice medicine.

The bill introduced in the Pennsylvania Senate would update the state’s nursing law to allow APRNs and nurse practitioners to function independent of physicians after they have practiced with them for at least 3600 hours over 3 years. The goal of Senate Bill 25, which was introduced by State Senator Camera Bartolotta, is to expand access to care for the 35% of Pennsylvanians living in rural locations or other areas underserved by primary care practitioners.

“Numerous studies have shown that patient health outcomes are as good or better under the care of nurse practitioners when compared to other providers,” Bartolotta said in a press release. “Many rural communities suffer from a severe lack of health care access, forcing many patients to travel an hour or more for care. Expanding the practice authority of APRNs is a logical step to help break down the barriers to quality health care services.”

The proposal to expand nurses’ practicing authority has been met with conflicting responses. It has garnered support from the Pennsylvania State Nurses Association and the Hospital and Healthsystem Association of Pennsylvania, with the latter declaring in a statement that APRNs “do not need unending physician supervision when caring for patients within the boundaries of their training” and that the bill is a “reasonable, responsible approach to helping to meet the growing health care needs” of the state.

The Pennsylvania Medical Society, however, opposes the bill, and has created an online resource urging its physician members to contact their senators and spread the word amongst colleagues “to protect quality patient care and patient safety.” Efforts by other health systems and states to expand the role of APRNs have provoked similar reactions split along professional lines. For instance, the Veterans Affairs health system’s move to extend practicing authority to APRNs last December was met with praise from the American Association of Nurse Practitioners but disappointment from the American Medical Association (AMA).

Policies expanding the practice authority of nurses, which have been adopted by 21 states and the District of Columbia, are not the only solutions being considered to address the scarcity of primary care practitioners in underserved and rural areas. A bipartisan group of US senators has introduced legislation in Congress that would amend the Conrad 30 program, which currently allows 30 foreign doctors per state to remain in the country after completing their residency under a J-1 visa in exchange for a promise of 3 years of service in an underserved area.

The new legislation would extend the program until 2021, make it easier for the doctors to get a visa, and potentially allow states to retain more than 30 of these eligible doctors from overseas, according to a press release from Senator Amy Klobuchar, D-Minnesota, who was one of the 3 Senators who introduced the law. The statement touted the support of the AMA and the American Hospital Association (AHA), which both emphasized the benefits of the Conrad 30 program for medically underserved communities.

“We must provide opportunities for American-trained and educated physicians to remain in the country and practice where there is an identified need for quality care,” said Senator Susan Collins, R-Maine, who co-sponsored the act, in Klobuchar’s press statement.

The third Senator in the group, Senator Heidi Heitkamp, D-North Dakota, concurred. “Families in rural America deserve access to the best doctors in the world,” Heitkamp said in the statement. “Making this critical program permanent would enable more doctors to use it to practice and support quality care in rural areas — that’s something everyone should want to accomplish.”

The act’s supporters hope that it is indeed accomplished in a timely manner, as the statement from the AHA noted that the current extension of the Conrad 30 program expires on April 28.