California Senate Passes Two Bills That Would Expand Scope of Practice


On Tuesday, the state Senate passed two of three bills that aim to expand certain health care providers' scope of practice as a means to address California's primary care physician shortage, the AP/Sacramento Bee reports (Lin, AP/Sacramento Bee, 5/28).


Only 16 of the state's 58 counties have the supply of physicians recommended by the federal government.

In addition, the Association of American Medical Colleges says that nearly 30% of California's doctors are nearing retirement age.

Meanwhile, the state is preparing to expand Medi-Cal and require most residents to have health insurance under the Affordable Care Act, which could exacerbate the shortage. Medi-Cal is California's Medicaid program.

Details of Bills

In February, state Sen. Ed Hernandez (D-West Covina) introduced a set of bills (SB 491, SB 492 and SB 493) that, respectively, would expand the scope of practice for nurse practitioners, optometrists and pharmacists to address the physician shortage (California Healthline, 4/17).

On Tuesday, the Senate passed SB 491 and SB 492, which now go to the Assembly for consideration.

Later this week, the Senate is expected to vote on SB 493.

Opposition to Bills   

The California Medical Association opposes all of the bills, saying the state should focus on alternate ways to address the physician shortage, such as:

  • Building additional medical schools;
  • Adding medical residency slots; and
  • Expanding programs to help physicians pay off student loans in exchange for working in underserved communities (AP/Sacramento Bee, 5/28).

Sen. Hanna-Beth Jackson (D-Santa Barbara) said, "To allow nurse practitioners to practice without any oversight endangers the community" (McGreevy, Los Angeles Times, 5/28).

She added that "we really need to make sure that even if people live in underserved communities that they get the best health care we can provide" (AP/Sacramento Bee, 5/28).
Linda Brokaw
In the 30 years I have practiced as a nurse practitioner, there have been study after study showing the quality and acceptance of the nurse practitioner compared to the primary care physician. Now, why don't we focus on providing that care equitably; payment for service by what ever provider? The ad shows the female shopper qualified to pick an appropriate beverage for her family; why not let the patient choose his or her provider? A quality medical home can be provided by a quality medical provider. That can be a MD, DO, NP, PA, PharmD; all are educated to provide the best care.Linda Brokaw,NP.
Rich Fidler
There are several points here. First, Hanna-Beth Jackson does not read current science. In an evidence-based culture that we have all adopted in healthcare, it is interesting that despite evidence that NP's can prescribe safely without oversight, ignorant people believe that only physicians can do this. Most of us who clinically practice ask for help when we see something outside of our comfort zone. Additionally, asking to build more medical schools takes many years, and then to ask for funding to pay off the physician loans seems excessive. Many physician residencies also limit the number of graduates solely for economic reasons, to keep supply low and reimbursement higher without regard to access-to-care issues. Without a clear difference in patient outcomes or satisfaction, rewarding an highly inefficient medical education system with loan forgiveness doesn't seem cost effective. NP's, PA's, OD's, and PharmD's are all responsible professionals that know when they need consultation

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