This spring, the US Department of Justice announced the launch of the Anticompetitive Regulations Task Force. The new task force is aimed at identifying and eliminating anticompetitive laws — at both the state and federal level — that are harming consumers, workers, and businesses.
When the task force invited public comments, we at the North Carolina Nurses Association submitted a direct response regarding North Carolina’s regulations on Advanced Practice Registered Nurses, which we believe are both anticompetitive and have a harmful effect on the public.
Advanced Practice Registered Nurses (APRNs) in North Carolina work under outdated regulations that restrict access to quality healthcare. These rules are inherently — and at this point, intentionally — anticompetitive.
Outdated physician supervision requirements mandate that many APRNs sign collaborative practice agreements with physicians. The level of “supervision” required to satisfy this mandate, however, is perfunctory at best: physicians and APRNs need only speak on the phone two times a year. They are not required to work in the same practice, the same city, or even the same state. Some physicians even prefer to “supervise” via text message.
Physicians do not typically supervise APRNs gratis. Many charge tens of thousands of dollars per APRN. While some hospitals and health systems might shoulder the financial burden for these agreements, any APRN hoping to start a community practice is forced to procure these contracts on their own.
Indeed, there are entire business models designed to take advantage of these outdated regulations. One medical practice in North Carolina openly advertised its ability to generate $60,000 or more per year in “passive income” for physicians willing to take on multiple APRNs.
On the other end of the spectrum, many private practice APRNs find themselves unable to secure a collaborative practice agreement at any cost, specifically because physicians do not want another practice opening nearby that could potentially compete for patients.
Meanwhile, our state’s APRNs are jointly regulated by both the Board of Nursing and the Board of Medicine. We should not have to clarify this but feel obligated to point out that APRNs are not physicians. It is rare that any single profession is allowed to exert this level of leverage over a different profession.
Modernizing APRN regulations is not a radical idea. At least 27 other states have successfully done so. Making similar changes would bring North Carolina in line with national standards recommended by the National Academy of Medicine, the National Council of State Boards of Nursing, and numerous other bodies.
North Carolina has introduced legislation to modernize its own laws six times in the last decade, garnering dozens of bipartisan co-sponsors. At least 29 organizations outside the nursing profession have voiced support for these bills. The only known opponent is the medical lobby.
APRNs are educated and trained to collaborate with other health-care professionals; they do not need a law to mandate artificial business relationships with physician “supervisors” to provide quality care. In fact, decades of research shows APRNs provide care as well as — and often better than — physicians when their scopes of practice overlap.
It is long past time for North Carolina to end anticompetitive APRN regulation and allow freedom of provider for patients all across the state.