Utah Takes the Lead Granting PAs and NPs More Practice Freedom

Utah recently became the first state to adopt a PA (Physician Assistant) Licensure Compact. The agreement recognizes the credentials of PAs licensed in one member state to practice in other states that are part of the compact.

The compact will allow PAs to increase patients' access to care and offset a projected shortage of healthcare providers, said Joshua Winters, MPA, PA-C, who works with Utah Valley Dermatology and is chair of the legislative committee of the Utah Academy of Physician Assistants.

"If New York had had this in place during the pandemic, a lot more providers across the country could have provided healthcare without having to travel to New York."

The American Academy of Physician Associates (AAPA) points to the need for cross-state practice authority, partly owing to the increased use of telemedicine.

While a 2020 survey by the organization found that three in four PAs used telemedicine for the first time, preliminary results of an AAPA report expected to be released in July indicate that 61% of PAs continue to use telemedicine or telehealth services.

The compact will also benefit PAs who need to move because of family obligations, such as having a spouse in the military, or who work for regional healthcare organizations that see patients in more than one state, AAPA reports.

For the PA compact legislation to take effect, seven states must adopt it. Bills have already been introduced in Minnesota, Ohio, Rhode Island, and Texas.

Coincidentally, the same day Utah adopted the PA compact legislation, the state also became the 27th, along with the District of Columbia and two US territories, to adopt full practice authority (FPA) for nurse practitioners.

The designation gives NPs more freedom from physician oversight to evaluate and diagnose patients, order and interpret diagnostic tests, and initiate and manage treatments, including prescribing drugs, according to the American Association of Nurse Practitioners (AANP).

April Kapu, DNP, APRN, president of AANP, praised what she called a bipartisan effort to pass the FPA legislation. "The people of Utah are now going to have greater access to care with more providers working in more places across the state," she says.

Utah's actions coincided with other changes for advanced practice providers, such as PAs and NPs. Utah, along with Delaware and North Dakota, is a member of the Advanced Practice Registered Nurse (APRN) Compact for NPs and other advanced practice nurses. The compact is being considered in Arizona, Hawaii, Kentucky, Maryland, Montana, New York, and Texas.

Like the PA compact, the APRN Compact will take effect when seven states have enacted the legislation.

Through the compact, APRNs can care for patients across state lines — both in person and electronically – without the additional time and cost of obtaining additional licenses, according to the compact's website. The compact also provides states with a uniform structure for regulating APRNs, the website reports.

The new licensing compacts are modeled after the Nursing Licensure Compact (NLC), which began in 1999, and highlight the findings of a recent Axios survey that nearly 1 in 3 patients who received medical care between 2016 and 2022 did not see a primary care physician. NPs made up the largest share (27%) of primary care providers at the time; PAs made up 15%.

Although NP and PA groups applaud the recent scope of practice advances, some doctor groups and labor unions continue to push back against the changes. Leaders of the Service Employees International Union and National Nurses United recently told Nevada Current, an online political and policy commentator, that joining the NLC benefits hospitals over workers, undermines collective bargaining, and fails to address bigger issues, such as patient-to-nurse ratios.

Such battles are likely to continue as more states consider offering nonphysician providers greater practice freedoms.

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Cite this: Utah Takes the Lead Granting PAs and NPs More Practice Freedom - Medscape - Apr 20, 2023.