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Less than half of the 139,000 licenses physicians in California are actively engaged in providing patient care. Of this number, only 32% are primary care physicians. The distribution of physicians also varies greatly by region with the San Joaquin Valley, Inland Empire and rural areas suffering the greatest shortages.

While a number of initiatives, including loan forgiveness and expanded residency programs, have focused on improving this situation. But it is not expected that there will be enough interested primary care physicians to meet the need for healthcare in California.

One of the top recommendations from the California Health Workforce Commission, representing thought leaders from business, health, employment, labor and government, after it spent a year looking at how to improve California’s ability to meet workforce demands, was to allow full practice authority for Nurse Practitioners.

The California Legislature responded in 2020 by passing AB 890.

A Nurse Practitioner (NP) is a registered nurse (RN) who has additionally earned a postgraduate nursing degree, such as a Master’s or Doctorate degree, and obtained a certificate from a certifying body.

At the state level, the Board of Registered Nursing (BRN) sets the educational standards for NP certification. According to the BRN, an NP is an advanced practice RN who meets BRN education and certification requirements and possesses additional advanced practice educational preparation and skills in physical diagnosis, psycho-social assessment, and management of health-illness needs in primary or acute care.

As a result of their additional training, NPs tend to perform additional functions through standardized procedures than non-advanced practice RNs. NPs also have specific authorization to furnish controlled substances and medical devices under standardized procedures, except that standardized procedures for Schedules II and III must include patient-specific protocols approved by a treating or supervising physician.

The passage of AB 890 ultimately added Business and Professions code section 2837.103 and 2837.104, which provided for Nurse Practitioners who were suitably trained and certified, to perform certain standardized procedures without physician supervision. The new law could not have effect until the BRN provided suitable regulations.

Taking AB 890 a step further toward implementation, this September the California Board of Registered Nursing (BRN) released a Notice of Proposed Action to the California Code of adding sections 1482.3 and 1482.4.

From the standpoint of California worker’s compensation claims, the implementation of this new law will in essence relieve shortages of physicians elsewhere, presumably adding services available for injured workers, and lowering costs for care. It is possible that the labor code could be later amended to define if and how NPs can directly be involved in care.

The Board has not scheduled a public hearing on this proposed action. The Board will, however, hold a hearing if it receives a written request for a public hearing from any interested person, or his or her authorized representative, no later than 15 days prior to the close of the written comment period.