Pennsylvanians are facing a major health-care provider shortage, particularly in rural areas.

But some medical officials have an answer to the growing problem: state lawmakers allowing nurse practitioners the ability to work independently of doctors. Those in the state House and Senate could see such a bill this session.

Nurse practitioners are allowed to evaluate, diagnose, order and interpret diagnostic tests and initiate and manage treatments, including prescribing medications. Unlike physicians, however, nurse practitioners have to enter into a business contract, called collaborative agreements, with two physicians to practice.

“We collaborate anyway. We don’t need an official document telling us what to do to serve our patients,” said Patricia Thum, who practices at a Cole Memorial-affiliated facility in Ulysses. She has been a nurse practitioner eight years.

She said there could be a change in the amount of independent practices in the four-county region. Full-practice authority would bring improved access and outcomes for patients.

Yet, what could be in store for the four-county region is up for debate, according to medical and state officials. 

“Pennsylvania is already facing a provider shortage — especially in rural areas. Unless lawmakers act quickly, our primary care system will not be capable of serving our existing patients, let alone the 600,000 new patients expected to gain coverage through Medicaid,” said Susan Schrand, CEO of Pennsylvania Coalition of Nurse Practitioners. “Getting insurance is an important step toward better health, but it can only help patients who have access to a health-care provider. Unfortunately patients have a harder time finding offices that accept new Medicaid patients. Those who do often face longer wait times to get an appointment.”

The Pennsylvania Coalition of Nurse Practitioners says that nurse practitioners are twice as likely to practice in rural areas than physicians. As well, nurse practitioners with full-practice authority in states that have granted it are most likely to practice in rural areas than nurse practitioners without full-practice authority.

A recent University of Pennsylvania study found that two of three primary care offices in the commonwealth do not accept new Medicaid patients. 

“The problem already is especially acute in rural communities, which already face a significant shortage,” the Pennsylvania Coalition of Nurse Practitioners said. “Rural communities have roughly half the physicians per capita as non-rural areas.”

In fact, urban and suburban areas have a physician for every 382 residents compared to rural Pennsylvania, which has one primary care physician for every 663 residents. A total of 2.5 million people, or 22 percent of Pennsylvanians in 55 of 67 counties, live in places deemed a shortage or medically underserved areas.

But Pennsylvania Medical Society spokesman Chuck Moran said putting an end to collaborative agreements would likely not improve health care in the four-county region.

“National geomapping studies clearly show that health-care professionals including nurse practitioners tend to settle near urban/suburban areas,” Moran told The Era. “The issue of getting health-care providers to rural areas is something of great interest to the Pennsylvania Medical Society, and we believe that medical school loan forgiveness programs and increased state-funded residency slots is the best proven way to get providers into underserved areas.”

As the struggle continues to recruit doctors to rural Pennsylvania, state Rep. Martin Causer, R-Turtlepoint, said physician assistants and nursing practitioners could help a great deal. The issue needs to be pursued, he said, adding that he believes it could be a benefit for rural Pennsylvania.

“Often, health-care systems specifically prohibit physicians in their employ from signing collaborative agreements with nurse practitioners who are not affiliated with the system. Some rural communities have only one system serving the community, meaning nurse practitioners are effectively frozen out from being able to serve that community,” reads a letter by the Pennsylvania Rural Health Association to state senators on Wednesday.

Many factors play into access to care in Pennsylvania’s rural communities, said state Rep. Matthew Baker, R-Wellsboro.

“Addressing CRNP (certified registered nurse practitioner) scope of practice legislation and the required nurse-physician collaborative agreement is one issue that can impact access to care in these rural counties,” he said. “However, the overall recruitment of all needed health professionals (i.e., physicians, dentists, advance practice nurses, pharmacists, etc.) is challenging for our state’s most rural communities.”

The need for more health professionals, along with broader economic challenges that rural communities are encountering, can make availability and access to health-care problematic, he said.

“As chair of the House Health Committee, I remain committed to taking a comprehensive approach in determining how the Commonwealth can best ensure that rural communities have the health professional supply that is most appropriate in light of local health-care needs,” Baker said.

Full-practice authority has the backing of the Institute of Medicine and the AARP, among other patient advocates. 

“Physician assistants, nurse practitioners and other health-care providers offer many potential benefits to rural communities. Needed changes to Pennsylvania’s licensure law would make it more likely for these dedicated professionals to see rural patients,” according to the letter by the Pennsylvania Rural Health Association.

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