Sally Pipes: Coronavirus deregulating health care — this should continue after pandemic is beaten
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In response to the coronavirus outbreak, the Centers for Medicare and Medicaid Services has rolled back regulations on hospitals and health care providers.
Hospitals are no longer barred from treating COVID-19 patients in outpatient facilities. The feds are also freeing nurse practitioners, physician assistants and medical residents to provide more care on their own. CMS is even issuing waivers that allow hospitals to provide meals, laundry service and child care while health care personnel are working.
{{#rendered}} {{/rendered}}Apparently, it takes a pandemic for policymakers to acknowledge that so many of the rules they've put in place serve little purpose. This crisis-driven effort to slash government red tape not only will help our nation defeat COVID-19 — it will yield a more efficient, higher-quality health care system post-pandemic.
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CMS is only the latest government entity to go on a deregulatory kick. Earlier in March, New York Gov. Andrew Cuomo signed an executive order that unwound years of health care labor market restrictions. It allows doctors educated at foreign medical schools to provide care without needing a license from the state. It permits respiratory therapists, physician assistants and nurses licensed in any state to practice in New York.
{{#rendered}} {{/rendered}}And it enables nurse practitioners and physician assistants "to provide medical services appropriate to their education, training and experience" without a doctor's supervision. New York is one of several states with "scope-of-practice" laws that prohibit nurse practitioners and physician assistants from writing prescriptions, diagnosing patients and more without approval from a physician.
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Rules like these have long made little sense. Both nurse practitioners and physician assistants hold graduate degrees and advanced medical training. There are currently 290,000 nurse practitioners in the United States, nearly 90 percent of whom specialize in primary care. Physician assistants often serve as the primary provider at clinics in rural or underserved areas.
{{#rendered}} {{/rendered}}Scope-of-practice rules also limit the supply of care available to patients. That's problematic, given that the U.S. health care system was short on qualified personnel before the coronavirus hit. The federal government has designated nearly 7,600 Health Professional Shortage Areas across the country; the collective population of these areas is more than 77 million.
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These shortages have been growing worse each year. The Association of American Medical Colleges projects that the United States will be short 122,000 doctors by 2032. The Bureau of Labor Statistics says the country needs over 200,000 additional nurses every year through 2026.
Empowering our existing crop of nurse practitioners, physician assistants and others can help narrow that shortage — and relieve the pressure the pandemic is putting on the health care system — in the short term. But in the long term, policymakers must make it easier for people to enter the medical profession.
{{#rendered}} {{/rendered}}It takes longer to become a doctor in the United States than almost anywhere else in the world. After completing a four-year undergraduate degree, students must endure four years of medical school before embarking on residencies and fellowships. All told, this process can cost close to $400,000. This long and expensive process discourages many promising young people from entering the medical profession altogether.
It doesn't need to be this way. Students in many European countries can earn a medical degree in a single, six-year program. Austrians and Swedes can complete their medical training even faster. Perhaps that's why Sweden and Austria each boast more than five physicians per 1,000 people, compared to just over two per 1,000 in the United States.
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{{#rendered}} {{/rendered}}In response to COVID-19, Harvard Medical School and New York University's Grossman School of Medicine have both given fourth-year students the option to graduate early. If America's top medical schools can truncate their programs in times of crisis, they should also be able to do so when things return to normal.
Not much good can come from a pandemic. A less regulated, more effective health care workforce may be one of the few positives.