Last April, at the beginning of the COVID-19 pandemic, Governor Ralph Northam recognized the value of nurse practitioners when he issued Executive Order 57. The Executive Order allowed NPs with at least two years of clinical experience to practice without a written or electronic practice agreement in the category in which they are certified and licensed until the end of the public health emergency. Since then, Virginia’s NPs have been working tirelessly to prevent community spread while continuing to provide primary and specialty care to patients of all ages and from all walks of life. This month, Virginia’s legislators will consider House Bill 1737, which seeks to make the regulations outlined in EO 57 permanent.
Nurse practitioners are advanced practice registered nurses who have master’s, and often doctorate, degrees as well as extensive clinical training in the diagnosis and management of common and complex medical conditions. Under current Virginia law, NPs must have five or more years of clinical experience to practice autonomously. Since April when EO 57 was enacted, there has been no negative impact on patient safety, and access to care has been improved.
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Making EO 57’s regulations permanent allow NPs to remain in Virginia (rather than leaving the commonwealth to work or volunteer) and provide primary and specialty care, especially in rural and underserved areas where physician shortages are greatest. It allows patients to develop relationships with their NP providers, which is essential for continuity of care. It also encourages NPs to develop innovative practice models, volunteer in free or mobile clinics without the restriction of a mandated collaborating physician and expand access to care in all specialties including mental health and substance abuse treatment.
Virginia’s collaborative requirement ties our state’s capacity to use NPs to meet health care needs to the supply and availability of the physician workforce. In addition, studies show states that restrict NP practice are more likely to have geographic health care disparities, higher chronic disease burden, primary care shortages, higher costs of care and lower standings on national health rankings.
Recent estimates from the Association of American Medical Colleges indicate the U.S. could experience a shortage of between 21,000 and 55,000 primary care physicians by 2023. According to The Senior List, 283 physicians are needed per every 100,000 residents to maintain a baseline balance between doctor supply and patient demand. Virginia currently has 262 physicians per every 100,000 residents, but nearly 30% of them are over the age of 60 and likely to retire in the next decade. By easing practice restrictions, NPs can help with this provider shortage.
Twenty-nine states, the District of Columbia and the Veterans Administration all have laws and regulations in place embracing the role of NPs and allowing for some level of practice autonomy. Of these, 16 states also require NPs to receive additional clinical experience before transitioning to an unrestricted license. For states that do impose an experience requirement before being eligible for autonomous practice, the limit is two or three years. Virginia is the only state that requires NPs to practice for five years before being eligible for autonomous practice.
Currently more than 25 percent of Virginia’s eligible NPs have applied for and received their autonomous practice license. The Governor’s executive order has significantly increased the number of NPs who can practice autonomously and provide care to Virginians. NPs cannot be a solution during a pandemic only to lose these advances when the emergency passes. Please ask your legislators to support HB 1737 and permanently increase access to health care for all Virginians.