Mar 7, 2024 4 min read

By Camera Bartolotta

We’ve all experienced long waits when trying to get medical care. If it feels more common than before, that’s because it is.

Burnout and retirements, particularly post-pandemic, created huge gaps in the number of nurses and doctors available across Pennsylvania.

Having fewer health care providers creates more issues than simply delayed medical care, though that’s certainly a big enough problem on its own. The shortage of medical professionals also impacts availability of all care. Without enough medical professionals, hospitals are either forced to close their doors because they can’t provide enough services to remain viable or pay traveling nurses at double or triple the standard rate and suffer the costly implications that often lead them to the same financial ruin.

The pain of this reality is especially profound in rural areas where people already have so much farther to travel to receive care. More than 100 rural hospitals in the United States have closed in the past decade, and another 600 rural hospitals – 30% of rural hospitals in the country – are at risk of closing in the near future.

Already, each year, approximately 3.6 million people in the United States miss their medical appointments because of transportation issues. Understandably, as people must travel even farther for care, this number will only rise – if they seek care at all.

When access to care is reduced, some patients’ health conditions remain untreated until they can no longer be ignored, and then patients end up in the emergency room. Others default to the emergency room for primary care when it’s not available elsewhere. Both approaches contribute to the overcrowding that delays critical emergency care other patients need.

In addition to the loss of access to health care, hospital closures result in higher mortality rates and unemployment rates, as well as lower per capita income.

All this at a time when the overall need for care is increasing. Population projections from the Center for Rural Pennsylvania and the Pennsylvania State Data Center suggest the commonwealth will have nearly 600,000 more residents 65 years of age and older in 2030 than it did in 2020. Of course, this will result in a greater demand for a range of health care services.

This dire situation will compound if it isn’t addressed. Luckily, there is a solution that actually reduces costs for Pennsylvanians, rather than raising them.

I sponsored a bill that offers a no-cost solution to this growing problem. Senate Bill 25 would expand access to high-quality health care by allowing qualified Advanced Practice Registered Nurses-Certified Nurse Practitioners (APRN-CNPs) to practice independent of a physician after fulfilling a three-year, 3,600-hour collaboration agreement with a physician.

Current law requires nurse practitioners to practice under a collaboration agreement at all times, which may lead people to believe the physician is actively involved in the care of the patients seen by the nurse practitioners he or she oversees. However, physicians rarely meet their nurse practitioners and almost never meet the patients. A collaboration agreement is simply an annual fee nurses must pay to receive a signature on a paper filed with the state board.

While we all understand nurse practitioners aren’t doctors, we must remember they go through a tremendous amount of training to provide care. It doesn’t end after they earn a master’s degree or a doctorate in nursing practice. They take graduate courses, complete clinical hours, pass national board certification and are licensed in their state.

They are more than capable of providing most of the care doctors can. By allowing nurse practitioners to practice to the full extent of their training, costs go down because they are reimbursed at a lower rate than physicians. Because of the increased access to care, nurse practitioners are also able to treat potential health challenges before they turn into severe medical conditions that are far more costly.

Full practice authority, which my legislation will grant nurse practitioners, will enable them to see nearly 1,800 additional patients each week.

Twenty-three states, the District of Columbia and every VA medical center across the country already allow full practice for APRN-CNPs. History has shown it works; during the COVID-19 pandemic, restrictions were lifted and nurse practitioners in Pennsylvania floated to the areas of greatest need, absent collaboration agreements. Patient care was not compromised.

Using the men and women who are already trained and live in our communities – rather than recruiting from elsewhere – to address unprecedented staffing shortages makes sense. We can empower families by fostering healthy communities.

It’s time to take this important step toward a more affordable and efficient health care system in Pennsylvania.

Camera Bartolotta is a Pennsylvania state senator representing the 46th Senatorial District, covering all of Greene and Washington counties and parts of Beaver County.