The AMA is strongly urging California Gov. Gavin Newsom to veto a bill—A.B. 890—that would allow nurse practitioners (NPs) to practice without physician supervision. In a letter to Newsom, AMA Executive Vice President and CEO James L. Madara, MD, explains that the bill "will not expand access to care in rural and underserved areas, increases overall health care costs and threatens the health and safety of patients in California."

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Patients, especially those with chronic conditions, want and expect their medical care to be directed by a physician. An AMA patient survey has found that 86% of respondents agree that patients with one or more chronic diseases benefit when a physician leads the primary health care team. A wealth of research illustrates these three main reasons why Newsom should veto the bill.It won't solve the rural access problem. Oregon, for example, has for decades allowed independent practice for NPs, yet "there is no measurable shift of nurse practitioners to the rural areas," Dr. Madara wrote, pointing to maps illustrating the state's health workforce patterns. "In fact," Dr. Madara wrote, "the evidence shows that states that require physician-led team-based care have seen a greater overall increase in the number of nurse practitioners compared to states that allow independent practice."It will raise health care costs, not cut them. That's because NPs tend to prescribe 20 times more opioids and over 400% more diagnostic imaging than do physicians. Researchers have found that "greater coordination in health care teams may produce better outcomes than merely expanding nurse practitioner scope of practice alone," Dr. Madara wrote.It threatens patient safety. NPs are essential members of the physician-led care team, but they are plainly not trained to practice independently. They are not required to undergo years of medical residency training and get only 500–720 hours of clinical training, compared with the 10,000–16,000 hours that physicians receive. The AMA's letter also notes the expert evaluation of A.B. 890 by Lawton R. Burns, PhD, which was submitted to the California Senate Appropriations Committee. He examined three practice functions allowed in the original Senate version of the bill, prescribing of antibiotics and opioids and reading of mammograms.

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