State Policy Network
Addressing the growing healthcare shortage: Scope-of-practice laws

The United States is facing a growing healthcare shortage—made worse by the coronavirus—that makes it difficult for Americans to access quality care. One way to address this problem is to reform scope-of-practice laws, the laws that regulate what services healthcare workers can provide.

What are scope-of-practice laws?

Scope-of-practice laws determine what services healthcare professionals, such as a nurses, nurse practitioners (NPs), physician’s assistants, and pharmacists, can legally provide—and in what settings. Think of “scope” as the list of services a healthcare professional are allowed to perform, such as diagnosing disease, prescribing medication, or treating illnesses.

In some states, even though a professional is trained to perform a certain service, such as prescribing medicine, their state’s scope of practice law prevents them from doing so. These overly restrictive scope-of-practice laws create healthcare shortages, especially in rural areas.

Nurse practitioners, for example, are registered nurses with advanced clinical training. In some states, nurse practitioners are allowed to make independent diagnoses, without the supervision of a physician. In other states, because of strict scope-of-practice laws, nurse practitioners are not allowed to do this.

Before we go any further, it’s helpful to understand the process for obtaining a healthcare license in the United States.

Who oversees the licensing of healthcare workers?

States are in charge of licensing healthcare professionals, so they set the rules on how someone earns a license (including education and training requirements) and what services they are allowed to practice once they have obtained that license. Every state is different, and each one has different regulations and requirements, which all fall under the state’s scope-of-practice laws.

When and why were scope-of-practice laws created?

Scope-of-practice laws were put in place to protect patients and public health. The thinking was, by regulating what services a healthcare worker can provide, and being overly cautious, the public would be protected from medical malpractice and other mistakes.

Do scope-of-practice laws make patients safer?

Although these laws were enacted to make Americans safer, there’s no evidence that shows they do. Research from the Mercatus Center at George Mason University finds that nurses and physician assistants can perform just as well as doctors in terms of patient outcomes—and patients were actually more satisfied with the care they received from nurse practitioners over doctors. 

What are some of the problems with scope-of-practice laws?

Scope-of-practice laws restrict access to healthcare. Even though some healthcare professionals are trained to perform a certain service, scope-of-practice laws prevent them from doing so. This makes it harder for Americans to access healthcare, especially for those who live in rural areas with few provider options.

Who would benefit from reforming scope-of-practice laws?

Many Americans struggle to get quality healthcare. Reforming scope-of-practice laws means expanding the services that qualified healthcare professionals can offer to patients. In other words, healthcare workers would be allowed to provide all of the services they were trained and educated to provide. Doing so would increase the number of healthcare workers who could provide common services  in the country and make it easier for Americans to get the healthcare they need and deserve.

The Mercatus Center at George Mason University has an excellent video that explains how scope-of-practice reform could help everyday Americans. The video tells the story of Jane, a mom who woke up one morning with a sore throat. She called her doctor, who said she could come in for an appointment in a week. If she had lived in a state that allows nurse practitioners to treat patients, she’d would have had more options for being treated and been able to see a nurse practitioner that day. But because of her state’s scope-of-practice laws, her sore throat had to go untreated for a week.

Mercatus also points out that by increasing the number of providers, states could dramatically reduce the cost of care for their residents. According to one study, allowing nurse practitioners to practice without oversight from a physician could save $810 million in healthcare costs.

How did the coronavirus impact scope-of-practice laws?

When the coronavirus hit in March 2020, many states relaxed their scope-of-practice laws so more providers could offer services and care. Qualified healthcare workers were able to practice to the full extent of their capabilities. Not only did relaxing the scope-of-practice regulations not put Americans at greater risk, the policy change resulted in reduced wait times for patients and freed doctors to focus on patients with serious conditions. Several state policymakers are working to make this temporary deregulation permanent and allow expansive scope-of-practice laws to extend beyond the coronavirus crisis. 

Additional Resources

State-Based Healthcare Reforms
State Policy Network

Scope-of-Practice Laws
Mercatus Center at George Mason University

It’s Time To Expand Scope Of Practice Laws
Stand Together

Organization: State Policy Network