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Let nurse practitioners work alone

Mass. should join other states in clearing a key hurdle to primary care.

Nurse practitioner Anne Krekis visits with longtime patient Henrietta Faison, 77, at the office is at Harvard Vanguard Medical Associates-Atrius Health.Pat Greenhouse/Globe Staff

What do patients really want when they have a bad sore throat or relentless back pain? To schedule a medical appointment without a ridiculous wait, get a referral to a specialist if needed, and escape with minimal financial damage — and, by the way, to get better.

Here’s what they don’t care about: which tribe within the medical community gets paid.

Legislation currently pending on Beacon Hill would move Massachusetts into the mainstream by loosening the restrictions on nurse practitioners, highly trained professionals who are certified to provide primary and specialty care and could easily be treating more of those coughs and muscle cramps than they do now. The bill would give patients more options, and could be especially important in underserved parts of the state where finding primary care remains a challenge. And by strengthening primary and preventative care, the legislation should improve public health and save money, too.

Nurses complete a master’s or doctorate degree and undergo extensive training to be licensed as nurse practitioners. They are trained to make diagnoses, order tests, and prescribe medicines. Right now, though, the roughly 10,500 nurse practitioners in Massachusetts must work under the supervision of an MD who has to review any prescriptions they write.


Massachusetts is one of the most restrictive states for nurse practitioners in the country. Doctors often exact hundreds or thousands of dollars in monthly fees from the nurse practitioners under their supervision — for doing work that the nurse practitioners are perfectly capable of doing on their own.

It’s an arrangement that doctors are battling hard to keep, arguing that nurse practitioners aren’t as well trained as MDs. But in states that allow nurse practitioners to operate independently — including every other New England state — there has been no documented damage to patient outcomes. On the contrary, studies compiled by the California Health Care Foundation suggest allowing nurse practitioners to work alone leads to fewer preventable hospitalizations and emergency room visits.


Superficially, the need for this reform in Massachusetts may not strike the Legislature as pressing. After all, when it comes to primary care, Massachusetts definitely is in better shape than most states. In fact, according to federal statistics, it had the largest surplus of primary care doctors in the country (Texas, meanwhile, had the biggest deficit). But the statewide statistics are skewed by the concentration of doctors in the medical mecca of Greater Boston. In rural parts of Western Massachusetts, some towns reported having no primary care physicians at all, and the federal government considers some areas of the state (including some parts of Boston) medically underserved.

Those are just the sort of areas that see more service when states allow nurse practitioners to operate independently, a 2018 study found.

It’s also worth it to curb the growing health care costs in the Commonwealth. The state’s medical costs watchdog, the Massachusetts Health Policy Commission, has recommended the state “amend scope of practice laws that are restrictive and not evidence-based.”

The agency has also noted, “These laws may represent an unnecessary barrier to cost-effective care.” Allowing advanced nurses to operate more freely and without making payments to doctors, it projected, would lead to a large increase in their numbers in the state.


Historically, as the Globe’s sister publication STAT has pointed out, laws restricting the scope of practice for nurses have carried a sexist tinge. Doctors have generally been male, and nurses generally female. Whatever their origins, such holdover laws just put up needless obstacles to health care access. Massachusetts may not have the same struggle as other states to attract primary care doctors but, even here, pockets of the Commonwealth are underserved and need the extra care that nurse practitioners could provide.