California Joins Movement to Give NPs Practice Autonomy

The national movement to grant nurse practitioners (NPs) greater autonomy reached critical mass this week when California Governor Gavin Newsom signed a bill that will allow NPs to practice on their own after a minimum of 3 years working under a physician’s supervision. Under current state law, NPs must always be supervised by a doctor.

The new law, enacted despite strong opposition from the California Medical Association (CMA), is scheduled to take effect January 1, 2023.

California joins 22 other states that allow NPs to practice independently, according to the California Association for Nurse Practitioners (CANP). Depending on how NP autonomy is defined, the number of states might be as high as 30, Joanne Spetz, PhD, a health economics professor at the University of California San Francisco, told Medscape Medical News.

About a dozen of those states passed their laws within the past decade, Spetz noted, and California is not the only large state in this category. Florida did the same earlier this year.

The significance of this trend has elicited a vigorous response from the American Medical Association.

“The American Medical Association has urged California Governor Gavin Newsom to veto Assembly Bill 890 since it offers no proven solution to expand access to care in rural and underserved areas,” AMA President Susan Bailey, MD, said in a statement emailed to Medscape Medical News.

“Instead, the bill would raise healthcare costs and jeopardize the health and safety of patients in California by asking them to settle for care from a healthcare provider with a fraction of the clinical training that physicians attain,” Bailey continued.

In California, Assembly Bill 890 was passed with the help of a CANP-led coalition that argued relaxation of the restrictions on NPs’ scope of practice would help alleviate the state’s severe provider shortage and increase access to care in rural and underserved areas.

In a news release criticizing the new law, however, the California Medical Association contended that access to care has not improved significantly in other states that have eased supervision of nurse practitioners.

“California still has a critical shortage of healthcare providers — including physicians — and AB 890 will do nothing to change the need for California to educate and train more physicians,” the CMA explains.

Anthony York, vice president of strategic communications for the CMA, told Medscape Medical News that NPs aren’t any more likely to practice in underserved areas than physicians are, and he said he’d seen studies showing evidence of that.

In contrast, Spetz said, “The literature is clear that greater autonomy for NPs facilitates their ability to go into rural areas.”

One of the studies she cited was a systematic review of studies of state laws that allow NPs to practice independently.

The review found that, in comparison with states with more restrictive policies, states that have given NPs greater autonomy tend to have more NPs in relation to the population, greater care provision by NPs, and expanded healthcare utilization, especially among rural and vulnerable populations.