To Improve Healthcare, Liberate Nurses

The most obvious way to avoid a huge imbalance between the supply and the demand for medical care (especially primary care) is to abolish the requirement that health plans provide a long list of preventive services with no co-pay or deductible. In addition, nurses, physicians’ assistants, and other paramedical personnel should have greater freedom to offer their services to the marketplace.

In Oregon, nurse practitioners with the proper credentials and licensure may open their practices anywhere they choose and operate in the same capacity as a primary care physician without oversight from any other medical professionals.[1] They can draw blood, prescribe medications, and admit patients to the hospital. In Texas, however, which has some of the most stringent regulations in the country, a nurse practitioner can’t do much of anything without being supervised by a doctor who must do the following.[2]

  • Not oversee more than four nurses at one time.
  • Not oversee nurses located outside of a 75-mile radius.
  • Conduct a random review of 10 percent of the nurses’ patient charts every 10 days.
  • Be on the premises 20 percent of the time.

Walk-in clinics manned by nurses in pharmacies and shopping malls seem to have overcome these legal barriers. But in poorer areas—especially in poor, rural areas—the obstacles may be insurmountable. In 2009, about 30 percent of Texas counties, most of them rural, had poverty rates of 20 percent or more.[3] Yet the farther a nurse is located from a doctor’s office, the less likely the doctor will be to travel to supervise the practice. In medically underserved areas, a doctor must visit a nurse practitioner at least once every tenth business day. Because of the shortage of practitioners, people living in poverty-stricken counties in Texas must drive long distances in order to get simple prescriptions and uncomplicated diagnoses.

California provides another example of the harmful effects of medical practice statutes: after more than 6,600 people overwhelmed volunteers at a free mobile health clinic in Los Angeles in 2010, California legislators passed a law making it easier for out-of-state medical personnel to assist with future events.[4] But because the state failed to adopt needed regulations, only medical personnel licensed in California could treat patients. Think about that: doctors from Nevada, Arizona, and Oregon can’t cross state lines to deliver free care to people who need it.

For more, please see my Independent Institute book, Priceless: Curing the Healthcare Crisis.


1. The Henry J. Kaiser Family Foundation, “Total Nurse Practitioners, 2010,” State Health Facts,

2. Virginia Traweek and John C. Goodman, “The Doctor’s Out, Where is the Nurse?” National Center for Policy Analysis, Brief Analysis No. 757, November 10, 2011.

3. “2010 County-Level Poverty Rates for Texas,” US Department of Agriculture Economic Research Services, December 2, 2011.

4. Anna Gorman, “Free Clinic Plagued by Red Tape,” Los­ Angeles­ Times, October 12, 2011,,0,1784326.story.

[Cross-posted at Psychology Today]

John C. Goodman is a Research Fellow at the Independent Institute, President of the Goodman Institute for Public Policy Research, and author of the Independent books, Priceless: Curing the Healthcare Crisis and A Better Choice: Healthcare Solutions for America.
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