Assemblyman Wood hails passage of bill allowing nurse practitioners to work without oversight of doctors

Culminating a two-year effort, Assemblyman Jim Wood secured approval of his bill allowing nurse practitioners to work without physician oversight, a move hailed by some advocates and steadfastly opposed by the medical establishment.

Wood, a Santa Rosa Democrat who leads the powerful Assembly Health Committee, and others tout the move as a way to address a statewide shortage of primary health care providers, especially in medically underserved rural and urban areas.

“I really believe in this policy,” said Wood, a dentist, expressing a “sense of relief, a sense of pride” in seeing the bill, AB 890, approved Monday by the Assembly and Senate on a combined vote of 80-4, sending it to Gov. Gavin Newsom’s desk for a signature or veto by Sept. 30.

“California has been successful expanding health care coverage to many more people — and that’s exactly what we should be doing,“ he said.

The California Medical Association asserts that nurse practitioners lack the depth of training required of physicians.

If signed into law, the bill would remove a legal mandate that the state’s 27,500 nurse practitioners need an agreement with a physician that spells out the scope of their work.

“It’s a beautiful thing that to have that requirement lifted,” said Surani Hayre-Kwan, a family nurse practitioner for 18 years at the Russian River Health Center in Guerneville. “We absolutely have to open up the ability of nurse practitioners to deliver care across the state.”

Wood said his bill, introduced in February 2019, met strenuous opposition by the medical association from the start.

“As we built momentum, the resistance got stronger and louder,” he said.

Dr. Rajesh Ranadive, president of the more than 800-member Sonoma County Medical Association, said the training requirements in Wood’s bill “don’t come close” to the seven years of medical school and residency required of physicians.

“That worries us as far as the quality of care that would be provided,” said Ranadive, a Petaluma internist.

Acknowledging that California needs to address the shortage of primary care providers, Ranadive said there is “no guarantee” nurse practitioners would opt to work in the most underserved areas.

Ranadive also said many physicians train for specialties that pay more than primary care.

The median base salary for full-time nurse practitioners was $110,000 last year and 69% deliver primary care, the American Association of Nurse Practitioners said.

The California Future Health Workforce Commission, which included Wood among its 24 members, said in a report last year that in a decade the state will face a shortfall of more than 4,100 primary care clinicians.

As one of its top 10 recommendations, the commission — co-chaired by former University of California President Janet Napolitano — called for maximizing the role of nurse practitioners “to help fill gaps in primary care.”

To boost the number of nurse practitioners to 44,000 by 2028, the commission recommended “providing them with greater practice authority, with particular emphasis in rural and urban underserved communities.”

Wood said his bill was “not revolutionary policy,” noting that 23 other states allow nurse practitioners to work independently, including Florida, which adopted the policy in March.

State Sen. Mike McGuire of Healdsburg, one of 19 Democratic co-sponsors of the bill, said it would “greatly improve health outcomes” in many areas of the state.

Naomi Fuchs, chief executive officer for Santa Rosa Community Health, said the bill is “a tremendous step forward to improve access to primary care for everyone in our community.”

“We look forward to welcoming more nurse practitioners to our community as independent providers and clinician leaders,” said Fuchs, whose organization has one of the first accredited nurse practitioner residency programs in the nation.

You can reach Staff Writer Guy Kovner at 707-521-5457 or guy.kovner@pressdemocrat.com. On Twitter @guykovner.