Nurse practitioners are nurses with advanced medical degrees and extra training. They are trained to diagnose, treat and prescribe medications to patients. Research generally shows that they do as good of a job as physicians, that their patients are happier and that their services are less costly.
But many states place strict limits on what services nurse practitioners can offer to customers. And state policy requires other regulations that decrease access and increase costs. Michigan is one of only 11 states that require nurse practitioners to be under the direct supervision of a physician in order to do their jobs. This means fewer nurses and medical facilities and worse care.
Michigan’s nurse practitioner rules make little sense in theory and even less in practice. The doctor supervision requirement costs a lot of money without improving services. The practical purpose of the law changes little in terms of how the patient is treated, but it means a nurse practitioner has to spend a lot of money to enter into a service agreement with a physician.
The requirement is a great deal for doctors, though. They make extra money for what is often not a lot of extra work. That’s why the physician-led associations fight against changes to scope-of-practice restrictions. The American Medical Association notes, that it has spent millions of dollars on radio ads, letter campaigns and advocacy grants. This protects a partial monopoly and financially benefits A.M.A. members.
Research shows restrictions on the scope of practice of nurse practitioners is associated with lower wages, an increased likelihood of nurses relocating and worse health outcomes for some populations. One study found that health insurers had to pay between 3% and 16% more for well-child visits in states with restrictive licensing laws for nurse practitioners. It also found “no evidence that the changes in regulatory policy are reflected in outcomes that might be connected to the quality and safety of health services.” Another study found nurse practitioners were far more likely to move to full practice states than restricted practice states. A 2022 study found that parents rated their children’s health better in states that allow nurse practitioners to practice independently.
Michigan should change the law and allow nurse practitioners to practice fully without physician supervision. Sen. Jeff Irwin (D-Ann Arbor) has introduced Senate Bill 279 to do so. It has a bipartisan group of co-sponsors.
The bill is supported by associations representing nurses but opposed by the Michigan State Medical Society. It is no surprise that associations are going to do what benefits their members. But lawmakers should be quite skeptical when interest groups impose government restrictions on their competitors for the financial benefit of their membership. Especially when the benefits of changing the law are so overwhelming.
Permission to reprint this blog post in whole or in part is hereby granted, provided that the author (or authors) and the Mackinac Center for Public Policy are properly cited.
Get insightful commentary and the most reliable research on Michigan issues sent straight to your inbox.
The Mackinac Center for Public Policy is a nonprofit research and educational institute that advances the principles of free markets and limited government. Through our research and education programs, we challenge government overreach and advocate for a free-market approach to public policy that frees people to realize their potential and dreams.
Please consider contributing to our work to advance a freer and more prosperous state.