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Scoping out health care worker shortages.

In areas where there are not enough doctors and nurses to keep up with the demand for their services--such as rural and underserved urban areas--state legislators are broadening the roles of some licensed health professionals through "scope of practice" laws. Supporters say that expanding the authority of nurse practitioners, physician assistants, dental hygienists and other oral health providers to perform additional procedures, treatments and actions would help alleviate health workforce shortages.

Legislators have considered dozens of bills over the past several years. New Jersey lawmakers, for example, voted last year to allow greater flexibility in the way physician assistants provide care. The law removed the requirement that a physician must always be present and allowed the physician assistant to work with a physician to define his or her personal scope of practice. Maryland and Nebraska passed legislation in 2015 to allow nurse practitioners to practice without physician oversight.

Scope of practice bills often bring out passionate advocates with different points of view. Proponents of these laws say licensed professionals can be trained more quickly and less expensively than physicians without compromising quality. Some physician groups disagree and argue that physicians' longer, more intensive training equips them to diagnose more accurately and treat patients more safely.

For those interested in more information, there's a new website created by NCSL and the Association of State and Territorial Health Officials that focuses on scope of practice policies for nurse practitioners, physician assistants, dental hygienists and dental therapists in all 50 states, D.C. and the territories. Find it at

Caption: Where the Needs Are Greatest

Primary Care Health Professional Shortage Area Scores by County

Scores range from 1 to 25: the higher the score, the darker the color, the greater the shortage. Scores are based on the population-tohealth provider ratio, the percentage of low-income population, the travel time required to reach a source of health care, as welt as infant mortality and low-birth rates.

Source: Health Resources and Services Administration Data Warehouse

The Rural-Urban Divide

(Per 100,000)               Rural   Urban

Primary Care Doctors         40      53
Nurse Practitioners          28      36
Physician Assistants         23      34
Dentists                     22      30
Specialists                  30      263
Population Over Age 65       18%     12%

Sources: Health Resources and Services Administration and Rural
Health Information Hub, the Rural Health Research Center at the
University of Washington, 2016.

Legislation Expanding the Roles of
Health Professionals

Bills Introduced and Enacted between 2015 and 2016

                Bills Introduced   Bills Enacted

Oral Health
Providers            39                  7
Practitioners        68                  9
Assistants           36                  10

Source: Scope of Practice Policy at

Note: Table made from bar graph.
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Title Annotation:STATESTATS
Author:Enlund, Sydne
Publication:State Legislatures
Geographic Code:1USA
Date:Mar 1, 2017
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