The COVID-19 pandemic has been but one justification for expanding PA and NP autonomy in some states. In New York, Governor Andrew Cuomo’s Executive Order 202.43 allowing autonomous advanced practice provider practice has impacted more than 13,526 PAs—more PAs than are licensed in any other state. This is, in my opinion, a good thing.
But the same pandemic has been utilized as leverage to permit and expand new areas of practice for others, too. These other forays and attempted expansions have raised many questions.
In Missouri, for the past few years, medical school graduates who could not match in a residency have been practicing as assistant physicians (APs), providing supervised primary care treatments. Now, the state legislature there is considering an expansion of the scope of practice and a path to full practice without any formal teaching residency. Virginia and New Hampshire have AP legislation pending as well. At the same time, Utah, Arkansas, and Kansas have already passed some form of legislation focused on expanding the scope of practice for other groups.
What is particularly interesting in examining why these physicians did not match to a residency is that they were far more likely to have failed the United States Medical Licensing Examination Step 1 and Step 2 exams on their first attempt. I believe that the issue is not a lack of residencies to match every medical school graduate, domestic and foreign, but rather residencies intentionally deciding not to select under-performing medical school graduates.
In part justified by the COVID-19 pandemic, Florida recently passed legislation—vehemently opposed by virtually every medical lobby (MD/DO/PA/NP) in the state—to allow pharmacists to provide limited primary care treatment, including independent prescribing of certain medications.
We see reports that both PAs and NPs are being furloughed or laid off during the COVID-19 pandemic, many from primary care practices. Why do we need these providers to step up if demand does not currently meet the supply of vetted, qualified PAs and NPs?