There’s a bit of a good news bad news situation on “scope of practice” rules coming out of California, as the State Assembly is advancing a bill to create some scenarios in which nurse-practitioners can treat patients without giving MDs a piece of the action but it’s only happening because “[a]mid fierce lobbying in opposition—including the California Medical Association, which represents doctors” the measure got watered-down quite a bit.
Ed Hernandez who sponsored the bill is also working on legislation to increase the range of things that pharmacists are allowed to do, inlcuding letting them give immunizations and prescribe some drugs.
Since medical licensing is done at the state level, we have quite a bit of evidence that shows that laxer scope of practice rules make health care cheaper without hurting patient outcomes. But I also think it’s important to try to drag this conversation a little bit out of the health care silo and into the larger labor-market silo. If you’re anything like me, you read dozens of articles a month gesturing at ideas like the “hollowing out of the middle class” and the decline of “medium-skill” jobs, with people worrying about a future in which the American economy is composed entire of 100 hedge fund managers and their butlers.
The kind of health care occupational categories that are hurt by the doctors’ cartel—trained nurses and pharmacists and technicians—are precisely the kind of mid-skill middle-class jobs that people are yearning for. Especially considering the fact that the population is aging and we’re trying to provide comprehensive health care to millions of people who currently lack it, there’s a huge jobs opportunity here. We should be training people to do these jobs and we should be letting them deploy their skills.