The California Senate is set to vote on a bill that would grant full practice authority to nurse practitioners (NPs). This bill (AB 890, Wood) would remove critical patient protections by allowing NPs to practice without physician supervision. The bill will be heard on the Senate Floor this week. Physicians are urged to contact their legislators now and ask them to protect patient safety and vote NO on AB 890.

Talking Points

Physicians are urged to call their legislators and tell them:

• AB 890 is poorly written, which is why the Medical Board of California and the Board of Registered Nursing are opposed.
• This bill asks the nursing board to develop standards for the practice of medicine, which is beyond their expertise and represents a danger to patient safety.
• NPs do not have adequate training or years of education to be qualified to practice medicine without physician oversight.
• Allowing practitioners to practice without physician supervision threatens patient safety, while also increasing overall health care costs due to overutilization of diagnostic tests and improper specialty referrals by undertrained nurse practitioners.

Background

The California Medical Association (CMA) strongly believes that simply expanding the scope of practice of allied health practitioners to give them independent and/or expanded practice will do nothing to improve access to care or quality of care in our state. Allowing practitioners to perform procedures they simply aren’t trained to do can only lead to unpredictable outcomes, higher costs and greater fragmentation of care.

As health care delivery becomes more complex, expanding the team of health care professionals that serves patients makes sense. However, it is not in the best interest of patients to abandon the current physician-led team approach to health care. Integrated team-based care led by physicians streamlines care, maintains and improves patient safety and decreases costs.

While an important part of the health care delivery system, nurse practitioners simply do not have adequate training or years of education to be qualified to practice medicine without physician oversight.

Physicians must prove their competency throughout their extensive residency training programs. In addition to their years of medical education and training, and ongoing requirements for continuing medical education, the California Legislature recently extended physician residency requirements to a minimum of three years before physicians are eligible for full licensure. If we are raising the bar for physicians, why would we let nurse practitioners practice unsupervised without holding them to the same standard as physicians?

This bill would instead remove necessary physician supervision, ultimately harming patients and decreasing quality of care. AB 890 attempts to provide a veneer of physician involvement by loosely identifying which circumstances could call for an NP to consult with or refer a patient to a physician or surgeon. However, NPs would not be required to proactively identify a physician or hospital for referral or transfer. Nor would they be required to disclose those details to patients. Without that information, patients will be unable to make informed decisions about their care and could be exposed to large surprise bills for out-of-network care.

AB 890 is merely an outline of a major policy change, which lacks critical details related to nurse practitioner competency requirements, scope limitations, requirements to actually serve underserved populations or regions, and many other details. As it stands, it is a dangerous bill that will do nothing to improve access to health care in California. 

The Medical Board of California and the Board of Registered Nursing are also strongly opposed to this flawed policy.

Contact your legislators today and urge them to vote NO on AB 890.