New California law lets nurses work independently of doctors

Gov. Gavin Newsom paved the way for nurse practitioners in California to practice medicine independent of doctors under a bill he signed Tuesday.

Newsom’s signature represents the culmination of a fight that has spanned several legislative sessions, pitting doctors groups against those that want to expand nurse practitioners’ ability to treat patients.

The measure, Assembly Bill 890, would allow nurse practitioners to practice independently in 2023. Nurse practitioners would have to operate under a doctor’s supervision for a minimum three-year transition period before embarking on their own practices. Current California law requires nurse practitioners, who hold masters or doctorate degrees in nursing and additional certification beyond a regular nursing degree, to always operate under a doctor’s supervision.

When it takes effect in 2021, the new law will direct the Board of Registered Nursing to establish a commission to oversee implementation and requirements. Nurse practitioners must notify patients that they are not physicians under the measure.

California will join 28 other states that already let nurse practitioners practice independently, according to legislative analyses of the bill.

Assemblyman Jim Wood, D-Healdsburg, who authored the legislation, said the measure aims to increase the number of primary care providers in California, where many rural and low-income communities don’t have enough doctors.

“The number of primary care providers in California is not increasing, and the population is,” he said. “It’s difficult to attract physicians in some areas. I can’t guarantee it’s going to be easy to attract nurse practitioners, but we know nurse practitioners are leaving the state.”

He said he hopes this new law convinces nurse practitioners to stay in California.

Opposition to the bill came primarily from doctor groups including the California Medical Association, a prominent advocacy group that has spent millions lobbying at the Capitol in recent years.

Sen. Richard Pan, D-Sacramento, a physician himself, said he doesn’t believe nurse practitioners have adequate training to practice medicine on their own, and said the limitations and guardrails in the legislation aren’t adequate to keep patients safe.

During a debate on the bill before it passed the Senate, Pan described the lengthy training doctors must undergo to practice independently, and pointed out that certifications for nurse practitioners are less rigorous.

“This bill… does not go far enough” to protect patients, he said.

Dr. Megan Frost Babb, a family practice doctor in Sacramento who has advocated against the bill with the group Physicians for Patient Protection, said she thinks the legislation is the wrong approach to alleviating California’s doctor shortage.

Nurse practitioners are a vital part of the health care system, she said, but their training is less standardized and less rigorous than doctors’. She worries allowing them to practice independently under the bill will endanger patients.

“There’s this rush to make it happen without putting the proper infrastructure in place to ensure that the quality of care is going to be the same,” she said.

Aimee Paulson, a nurse practitioner in San Ramon, had hoped to start her own practice if the bill had passed. As a nurse practitioner specializing in family practice, Paulson sees patients of all ages for wellness visits, management of chronic conditions and minor in-office surgical procedures. She refers patients to a specialist for more complicated or uncommon procedures, or when a patient requests a referral.

When she consults with the doctor she works with, she says he often jokes that if she doesn’t know something, he probably doesn’t either. Paulson, who advocated for the bill as the health policy director for the California Association for Nurse Practitioners, rejects the argument that allowing nurse practitioners to practice independently would endanger patients.

“Being in family practice, there are natural limitations in your scope. I’m not going to be handling someone’s knee surgery,” she said. “Physicians do have more training than nurse practitioners, but the training that nurse practitioners have is absolutely adequate for our scope of practice.”

Having her own practice would allow her to continue treating the same patients she has developed relationships over the last 14 years of her career even if the doctor she works with retires, Paulson said.

“That’s what’s so amazing about family practice,” she said. “You really develop a relationship and partnership with people, and it’s really hard to do that if you have to pick up and move.”

Sophia Bollag covers California politics and government. Before joining The Bee, she reported in Sacramento for the Associated Press and the Los Angeles Times. She grew up in California and is a graduate of Northwestern University.
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