Two views: Patients need greater access to health care

With the passage of the Affordable Care Act, California has seen more than 2 million people join the ranks of the insured. Many of these people are in rural areas such as ours that already face doctor shortages. This leaves many people with limited options for primary care.

As a nurse practitioner at the Russian River Health Center, I know that California can take immediate steps to increase the availability of health care providers in our area. Senate Bill 323 would allow nurse practitioners like me to work with increased flexibility while continuing to provide primary care.

Current law requires that nurse practitioners have an operating agreement with a doctor before practicing. This agreement doesn’t mandate direct supervision, only consultation - which could mean that the doctor will come by the clinic or facility once a week or review files remotely without actually visiting.

In my practice, I work with all ages - from newborn babies to 99 year olds. I deal with homeless, drug addiction, chronic diseases, cancer and healthy families. Sometimes I work with a doctor, but other times I don’t have a doctor in my clinic. I also have my own set of patients who I diagnose and follow up with to ensure that they are following the prescribed treatment. The current system requires that I refer patients for procedures not in my operating agreement, and this requires the patient to set up another appointment. Many of my patients are working and either cannot take more time off or don’t have flexible schedules to find a doctor to help them.

SB 323 wouldn’t allow me to do any more that I do today, but it would eliminate bureaucracy that at times hinders my ability to practice. SB 323 would continue to require collaboration, just as I practice today. If I run into a situation that requires expertise out of my ability, I refer that patient to the appropriate specialist.

We have far too many sick and elderly people using the emergency room as their entry point into the health care system. A recent study from the Bay Area Council shows that SB 323 would increase the number of nurse practitioners in California, especially in rural areas, and save the state money by increasing the number of preventative care visits - instead of having patients use the emergency room for primary care. Twenty-one other states already allow nurse practitioner to have full practice authority, and the results are promising.

While some opponents have raised safety concerns, studies by the Institute of Medicine have shown that nurse practitioners deliver the same quality of care as a physician.

Surani Kwan is a nurse practitioner at the Russian River Health Center in Guerneville.