Opinion | Nurse practitioner bill is full of false promises, bad for patients

As a physician, I am very concerned about the impact of Senate Bill 279, which would remove the requirement that nurse practitioners (NPs) work as part of a patient-centered, physician-led care team.

The bill is touted as the answer to rising health care costs and access, but it does not include any mechanism or mandate to address either.

In short, the legislation is a big promise that will never deliver.

That’s a strong conclusion, but it is absolutely appropriate, given the overwhelming amount of data demonstrating that health care workers practicing beyond their education and training results in higher costs and worse outcomes for patients. 

A recent side-by-side study showed that shifting to non-physician-led health care teams resulted in patient referral to a specialist at an 8% higher rate per disease, a 1.8% higher likelihood of an emergency room visit, and up to $119 more out of pocket, per month, per patient. 

All of that makes money for the health care system, but it comes out of the pocket of patients. 

A working paper by the National Bureau of Economic Research found that NPs, compared to physicians, increase patient length of stay (11%), raise the cost of emergency care (7%) and raise 30-day preventable hospitalizations (20%).  Their summary: ”NPs use more resources but achieve worse patient outcomes relative to physicians.

Further, in states that have passed similar legislation, studies show that independent NPs and PAs do not go to rural communities, instead they subspecialize and stay in urban areas.  In doing so, they widen the rural-urban health care gap.

That isn’t good for Michigan patients, especially in the rural areas of northern Michigan where I work. 

To be clear, these are not my personal opinions. This is data from published, peer-reviewed articles from medical, economics and nursing journals.  

And to be crystal clear, this isn’t a turf war between health care practitioners. You may be surprised to learn that there is not uniform support in the nursing community for removing physicians from the health care team. 

An article in the Journal of Nursing Regulation concluded that “… NPs should not perform independent, unsupervised care … regardless of state law or hospital regulations in order to protect patient safety.”

This is a fight for you — the patients—to get the best quality medical care from the highest trained individuals at the lowest cost out of pocket.  

You deserve that, and the patient-centered, team-based, physician-led model of care is the only proven and time-tested way to deliver it. 

A compassionate team of trained experts, all working in conjunction and to the peak of their training and expertise towards the safest and most effective outcomes is what we all want and expect from our health care system. 

Thankfully, that’s exactly what we have now here in Michigan.

The proposed legislation jeopardizes all of that: SB 279 will not improve your access to health care, but it will increase out-of-pocket costs and—most worrisome—take physicians away from patients.

There should be no room for cutting corners when human life is on the line. For the health and safety of patients everywhere, we need to put a stop to scope of practice expansion.