April 3, 2023
Proponents of the SAVE Act claim the legislation is necessary to expand access to care in rural areas. However, physicians and nurse practitioners largely practice in the same areas of the state – even in states where nurse practitioners can practice without physician supervision or collaboration. For the most part, state laws that have expanded the scope of practice of nurse practitioners have not had an impact on expanded access to care in rural areas.
The Graduate Nurse Education Demonstration Project involved the Centers for Medicare & Medicaid Services (CMS) providing payments to five eligible hospitals, each of which partnered with schools of nursing to expand clinical education for additional APRN students1. One of the objectives of the project was to determine if funding clinical APRN education would increase the number of APRNs and to determine the employment choices of APRNs following graduation. A study of alumni from this program found 91% of nurse alumni were in urban settings, and only 9% went to work in rural areas.
Patients in rural and underserved areas, often a vulnerable and medically complex population, should not settle for care from a health care provider with a fraction of the education and clinical training of physicians. All patients, regardless of zip code, deserve care led by a physician. Policymakers should consider proven solutions to increasing access to care, including supporting physician-led team-based care.
Other proven reforms include telehealth expansion, expanding Graduate Medical Education slots, loan forgiveness programs for physicians practicing in rural and underserved areas, and programs that encourage students from underserved areas to pursue medical school.
The NC Patient Safety Coalition is an alliance of medical professionals that advocate for physician-led health care that protects patient safety. Learn more on our website at www.ncpatientsafety.com, and follow us on Twitter @NCPatientSafety and Facebook www.facebook.com/NCPatientSafety.