George Gibbs Center for Economic Prosperity


By: The James Madison Institute / 2017

Florida lawmakers are considering legislation to allow advanced practice registered nurses (APRNs) to practice independent of supervising physicians.

House Bill 7011, sponsored by state Rep. Cary Pigman (R-Sebring), would let APRNs “practice advanced or specialized nursing without physician supervision or protocol” upon registering with the state Board of Nursing, according to the official bill summary.

The bill was approved by the House Health and Human Services Committee on April 20 and awaits further action before Florida’s 60-day regular legislative session concludes in May.

Patients in Mind

Pigman, a medical doctor, says APRNs are well-equipped to treat patients within their scope of practice without physician supervision.

“An APRN must have a [Bachelor of Science in Nursing], a four-year curriculum, followed typically by two years of clinical practice as a nurse, then complete a master’s degree or doctorate level of training in advanced practice nursing,” Pigman said.

Typical APRN training focuses more on patient care than the training experienced by medical doctors (MD) or doctors of osteopathic medicine (DO), Pigman says.

“An APRN’s background is a little more patient-care focused,” Pigman said. “They have experience of several decades proving safe and effective practice. Almost all MD/DOs go on for residency training, which can be as few as three years but can span many more years. This leaves the MD/DO’s background a little more science-focused.”

Supervision Costs

Letting APRNs use the full range of their training would reduce the cost of care, Pigman says.

“All costs are always passed through to the consumer and payer,” Pigman said. “It would allow APRNs to practice to the full scope of their training and skills. It would remove the costs associated with supervised practice.”

Unnecessary supervision of APRNs by physicians increases the cost of care, Pigman says.

“These costs include actual fees charged to APRNs by MD/DOs who supervise them, as well as the more hidden cost of the time spent supervising by the MD/DO that could be more productively spent seeing patients,” Pigman said.

Special-interest groups opposing the bill would profit at the expense of patient choice, Pigman says.

“The only opposition comes from some MD/DOs who see APRNs as competition to their practice and income,” Pigman said. “My belief is that we have such a shortage of health care providers that there are more than enough patients to keep everyone very busy.”

Dwindling Doctor Supply

Sal Nuzzo, vice president of policy at the James Madison Institute, says lawmakers should encourage growth in the state’s supply of health care providers now to prevent shortages later.

“Florida has been a flashpoint for the supply chain shortage in health care,” Nuzzo said. “We need to address a projected shortage of more than 25,000 primary care physicians over the next 15 to 20 years.”

Expanding the supply of providers to non-physicians would help maintain patient access to health care, Nuzzo says.

“Florida stands to lose a significant number of primary care physicians over the next 15 years due to attrition,” Nuzzo said. “A large percentage of our existing doctors are approaching retirement age. We do not currently have an adequate pipeline of docs in training to meet that plus population growth.”

Econ 101

Patients should be free to obtain care from APRNs as a proven safe alternative to physicians, Nuzzo says.

“The numbers do not lie,” Nuzzo said. “This policy will allow patients the ability to receive care from highly qualified providers. Despite claims to the contrary, provided there is open information, allowing patients the ability to choose to receive services from an APRN should have very little negative side effect.”

Expanding the ability for APRNs to practice will increase options for patients and drive down health care prices, Nuzzo says.

“The dynamics of economics 101 will absolutely hold,” Nuzzo said. “When we inject more supply into the existing system, we will help put downward pressure on the price. That can only help consumers.”

Ben Pyle( from Cedarville, Ohio.