A bill that would provide an avenue for nurse practitioners to practice independently without the supervision of a physician edged through its first committee hearing Thursday after being saddled with an amendment requiring them to receive far more training.
The House Health, Welfare and Institutions Subcommittee was standing-room-only as nurse practitioners and physicians — many wearing white medical coats — showed their support or opposition for House Bill 793, sponsored by Del. Roxann Robinson, R-Chesterfield.
The bill, which would give nurse practitioners full practice authority, has been met with skepticism from some doctors, who are currently required to supervise the nurses’ work.
Proponents argue that allowing nurse practitioners autonomy would vastly increase access to care, a growing need as almost all parts of the country, especially rural areas, are grappling with health care provider shortages.
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During the hearing, two substitutes were suggested for the bill — one proposed by Robinson, the other by the subcommittee’s chairman, Del. Scott Garrett, R-Lynchburg, who is a physician.
Robinson’s substitute increased the number of hours of clinical experience a nurse practitioner would need before becoming eligible for full practice authority from 1,040 hours in the original bill to 3,000 hours — which is equivalent to 1½ years of training.
The other substitute increased the requirement to 10,000 hours, or five years of training, and that substitute was ultimately the one that the subcommittee decided to recommend to the full committee.
Proponents of the change argue that 10,000 hours is an excessive requirement, and would make Virginia an outlier among the 22 other states — along with the Veterans Health Administration — that have already allowed nurse practitioners a route to full practice authority. The average, they said, is 3,000 hours of clinical training.
“Nurse practitioners do not want to be M.D.s, but they do want to practice to the full scope of their training,” Robinson told the committee. “They have been providing competent, safe health care to patients for years, often in settings where the collaborating doctors are many miles away or even in another state.”
But the other side — led during Thursday’s hearing by the Medical Society of Virginia — argued that physicians are a necessary part of the patient care team. Many spoke of the extensive time and money medical students pour into their education to become qualified physicians.
“With the capabilities of telemedicine and communication today, it is easier than ever to collaborate and ensure that proper clinical supervision has been obtained,” said Dr. Kurtis Elward, the MSV president. “Nurse practitioners in areas where they are providing needed access have all the support they need.”
One medical student speaking in favor of the 10,000-hour requirement asked why someone would dedicate 10 years and hundreds of thousands of dollars to becoming a doctor if they could be so easily eliminated by someone who could get it “faster and cheaper,” a comment that was met with an outcry from the crowd, about three-quarters of whom were nurse practitioners themselves or supportive of the bill.
While he spoke with the caveat that he would like to see more conversations to create a plan both sides support, Del. Mark Sickles, D-Fairfax, was the only member of the subcommittee to speak favorably of Robinson’s 3,000-hour suggestion.
But Sickles’ attempt to keep the 3,000-hour standard failed, and Garrett’s version of the bill requiring 10,000 hours moved on instead.
Garrett told the crowd that the bill still has a long way to go before it becomes law and, before the end of the meeting, Robinson made sure it was clear that she is still the bill’s sponsor.
“This will continue to be my bill, not the chairman’s bill, as it moves through the process — just for clarification,” she said.
