Doctors more worried than ever about nurse practitioners getting expanded role

California doctors’ long-held opposition to nurse practitioners expanding their scope of practice into areas now reserved exclusively for doctors has become even more intense with the growing evidence that medical technology enhanced by artificial intelligence can play a much bigger role in health care. Nurse practitioners with such powerful tools could conceivably supplant doctors in many areas of medicine.

But state lawmakers — concerned about California’s increasingly severe physician shortage — seem ready for big changes. Last month, the Assembly Business and Professions Committee voted 16-0 for Assembly Bill 890, by Assemblyman Jim Wood, D-Healdsburg. It would allow properly certified nurse practitioners to order and interpret diagnostic procedures and to prescribe some drugs, among other duties, without supervision by a medical doctor.

In 2013 and 2015, bills expanding nurse practitioners’ scope of duties passed the Senate before dying in the Assembly. That makes the unanimous Assembly committee vote look even more significant.

The committee first heard testimony about the findings of the California Future Health Workforce Commission, which warns the state faces a shortage of 4,100 doctors in coming years. In February, the commission — chaired by University of California President Janet Napolitano — urged California to join the 22 states which already allow nurse practitioners to work without a doctor’s supervision in some areas of health care.

CMA: Change would lead to lower quality of care

That prompted criticism from the California Medical Association: “We continue to oppose efforts to lower standards of care to expand access. Nurse practitioners, while hugely important to the health care delivery system and an integral part of medicine, do not have the same level of training and expertise, and we should be wary of creating a system that only allows those patients who can pay top dollar access to a fully trained and licensed physician.”

But a March report by the Brookings Institution pointed to a future in which such physicians are much less important. It noted research that showed an artificial intelligence system “was equal or better than radiologists” at evaluating mammograms; that computers are as competent as ophthalmologists in examining some retinal images; and that robots which performed intestinal surgery on a pig did much better than humans with the sutures used to close up surgical incisions.

Bay Area physician Rahul Parikh, writing in October in the MIT Technology Review, thinks specialists may be in trouble — but not family doctors, who can use artificial intelligence to improve their care. And he argues that any transition to a health care system reliant on AI will face profound questions.

“Are patients willing to share more of their personal data with us? If the AI shows your care is better one way, but you or your doctor feel differently, will an insurance company accept it?” he wrote. “What if the algorithm misses something or is applied incorrectly? Who is liable, the doctor or the machine’s maker?”

Assembly Bill 890 will be heard next by the Assembly Appropriations Committee. No hearing date has been scheduled yet.