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Taking the leash off of Nurse Practitioners and why this is great for Arkansans

By JD Haigler

The healthcare fight is an ongoing one in Arkansas as the Arkansas Medical Society continues to lobby hard to protect the money coming into hospitals across the state.  Several things like ‘Telemedicine’ have been almost impossible to push through because of their efforts until the pandemic necessitated it.

Similarly, the freedom for Advanced Practice Registered Nurses (APRNs) to practice medicine without the supervision of a Doctor has been contested by the AMS.  Two bills have been filed in the last week that directly affect this situation.

SB186 would remove the “Collaborative Agreement” requirement from APRNs after 1000 hours.  What this means is that after the specified time period, a certified APRN could run their own clinic without needing the supervision or association of a Doctor to essentially rubber stamp their prescriptions.  This could accomplish two things.

  1.  Access.  Doctors are in short supply already, and the ones that are out there are primarily in hospitals and cities.  Rural areas only have a handful of doctors, which complicates transportation means and scheduling.
  2.  Costs.  APRNs are a more affordable option for most medical dilemmas, and will introduce direct competition to the medical monopoly that hospitals hold over much of Arkansas.

The second bill is HB1254, which would allow Medicaid patients in the state to use APRNs as their Primary Care Provider.  This is in conjunction with the previous bill, allowing for independent APRNs to be available to the whole medical customer base.

Conversely, the Arkansas Medical Society will contest these bills.  They have in the past argued that:

  1. The level of expertise/care is not the same.

The level of expertise/care should not be confused with level of certification, and because of that certification and education, you pay up to a third to double the cost, with little to no benefit for 90% of medical issues. According to the Arkansas Nurse Practitioner Association, “Certified Nurse Practitioners (CNP) led care is associated with lower mortality and hospital admission rates than physicians (Martinez-Gonzales et al., 2014). Studies have found that CNPs who practice independently provide high quality care that produces outcomes that are equivalent or superior to physicians in measures of quality, safety, and effectiveness in a variety of care models (Stanik-Hutt et al., 2013)”


  1. A collaborative agreement needs to be required.

This means that a relationship needs to be established with a supervising doctor who is essentially on call.  APRNs argue that this already exists.  They already push referrals to doctors when it’s over their head.  It’s what they do organically for the health of the patient, and they don’t need an expensive collaborative agreement to force them to do it.

The bottom line is that what the AMS is actually worried about is protecting the money coming to their physicians.  In 2015, the North Carolina Nurses Association conducted a study which showed that removing the required association with a doctor would accomplish the following:

  • Save State Healthcare costs at least $477 million
  • Create 3,848 jobs
  • Reduce primary care practitioner shortages by 92%
  • Add $20.7 million to State/Local tax revenue

The Arkansas Medical Society backs their opposition to SB186 and HB1254 and similar bills  with concern for Arkansans, but at the end of the day, they’re concerned about money leaving the Doctor’s offices and going to localized Nurse Practitioner clinics.  Is it a valid concern?  Almost certainly.

However, according to reports by the American Association of Medical Colleges (2012), the U.S. will experience a physician shortage upwards of 100,000 physicians by 2025.  There simply aren’t enough Doctors to keep up with the demand.  There’s ample room for Nurse Practitioners to step in and fill the gap before Doctors see a loss of revenue.

Furthermore, this is a free market.  Medical costs are high in large part due to the monopoly on healthcare that Doctors hold in this state.  What the AMS is trying to do is keep that monopoly locked down while claiming to worry about the patient, yet ignoring the growing shortage in physicians and the lack of localized care in rural communities.

These two bills go a long ways towards correcting that.  Both are currently in the Public Health Committee, and you can be sure the AMS will testify against them there.  Contact your Legislators if these matters connect with you, and let them know where you want them to represent you on these bills.

About the Author:

James Haigler is a political pundit in Northeast Arkansas, heavily involved in local campaign efforts, based in Jonesboro.

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