Licensing laws define access to health care workers and determine the availability of services in a wide range of markets. In Pennsylvania, nurse practitioners must sign a CPA with two doctors to meet the state`s licensing requirements. The agreement is a written contract outlining the benefits a nurse can provide and the conditions for the physician`s participation in care. A nurse without a CPA cannot practice. As Mr. Gilman pointed out, the CPAs are challenging two principles of competition policy for nurses with respect to professional licensing policy: are the rules harmful? As a result, do the regulations take the proposed risks effectively? As in 23 other states, Pennsylvania requires nurses to maintain a Collaborative Practice Agreement (CPA) with a physician as a condition of the state`s professional license. At a recent LDI seminar, Dan Gilman, legal counsel for the Federal Trade Commission`s Office of Policy Planning, provided an appropriate framework for examining how mandatory CPAs can affect the provision of health services to consumers. A signed CPA does not mean which collaborative services, if any, are available to the nurse. The model and frequency of medical cooperation are not standardized by law or by law. Collaboration with physicians may include on-site case consultation for all patient meetings with a physician or signing medical records. In Florida, the CPA study revealed significant variability in the collaborative services actually provided.

In a national study of nurses, the majority of nurses did not see improvements in patient safety or quality as part of a CPA. Sometimes a nurse cannot find a cooperating doctor, which can happen in rural and outpatient settings with fewer doctors. The nurse would not be able to enter into practice in markets where the need is greatest. About 35% of Pennsylvania residents report an unrealized primary supply need. Although the state has an above-average number of medical students, less than a third practice here. Strict professional licensing requirements, which bring nurses closer to a limited number of doctors, exacerbate the labour shortage, although well-established evidence of the safety of nurses as primary care providers is growing. Dr. Gilman`s second thought is whether the regulations are effectively addressing the proposed risks. To date, the conditions of CPAs are unknown between nurses and doctors.

In Pennsylvania, agreements are maintained in the Nurse Practitioner Practice Center without the need to audit the public nursing administration. Only the names of cooperating physicians are registered at the national level. There is no evidence that agreements help reduce risk and improve safety or quality.