By Ann Sheehan, DNP, CPNP, FAANP
Access to healthcare is an essential need for all human beings and access to primary care is essential for a healthy population. Primary care provides continuous, comprehensive, and accessible care, while focusing on prevention, early detection, and management of health conditions. By fostering strong patient-provider relationships and coordinating care across the healthcare system, primary care improves health outcomes and enhances the efficiency of healthcare delivery.
Healthcare access involves more than just being able to schedule an appointment with a healthcare provider. The Agency for Healthcare Research and Quality (AHRQ) specifies that access to healthcare means having timely use of personal health services to achieve the best health outcomes. To have adequate access to healthcare an individual must have: coverage for care, service availability, ability to schedule a timely appointment, available workforce, and geographic proximity. Insurance coverage can direct patient care access by telling the individual where and when they can receive healthcare. Services refer to the ability to receive recommended screening and preventive services. Timeliness is the ability to access healthcare when a need arises. Workforce refers to the ability to access care from a qualified, culturally competent provider. Additionally, healthcare needs to be geographically convenient to access. There are many rural areas of Michigan where patients much drive further than the next county to access healthcare.
Access to primary care helps reduce health disparities and promotes a more equitable healthcare system. This is important for Michiganders as approximately 60% of the adult population suffers from at least one chronic disease, and many adults are coping with multiple chronic diseases. This chronic disease burden has a significant economic impact on our state.
The chronic disease burden is magnified as Michigan faces a significant shortage of healthcare providers, particularly in primary care. This shortage is more acute in rural areas, where 72 of Michigan’s 83 counties are designated as Health Professional Shortage Areas (HPSA). This shortage extends beyond physicians to include nurse practitioners, physician assistants, and other healthcare professionals. HRSA reports that the demand for healthcare services across the United States is on pace to overtake the supply of healthcare providers in the very near future. The American Medical Association (AMA) reports that only 57% of physicians currently work in primary care.
Becker’s Hospital Review reports the time to the next primary care appointment in Michigan is 24-29 days and the time to next new patient appointment is about 38 days. Michigan’s wait times are on par with national trends. These reported wait times can be much higher in rural or provider-shortage areas.
Nurse Practitioners (NPs) play a crucial role in addressing healthcare access issues, including in rural and underserved areas. However, in Michigan, NPs face several limitations that restrict their ability to practice independently. Unlike states with Full Practice Authority (FPA), Michigan requires NPs to have a supervising physician, which can limit their ability to provide care, especially in rural and underserved areas.
Today 30 states and US territories allow nurse practitioners to practice to the full extent of their education, training, and certification. Over the past 10 years, there has been a 40% increase in the number of states that permit NPs to treat patients without the involvement of a physician. This legislative session, the Michigan Legislature has the opportunity to join this movement and become the next state to engage NPs in FPA.
In April 2023, Senator Jeff Irwin introduced SB 279 in collaboration with the Michigan Council for Nurse Practitioners (MICNP) with bipartisan support. Irwin supports this legislation because FPA for NPs will make Michigan more competitive with other states and help close the health care gaps in rural and urban areas of Michigan. Improving the restrictive practice environment in Michigan will enable NPs to practice at the top of their education, training, and certification and will allow NPs to serve a vital role in improving access to healthcare services for the increasing number of patients seeking care. Ultimately, this means the time to the next available appointment will be shorter. If patients are not able to access care, their health will be compromised, and healthcare costs will continue to rise. It is well documented that regular access to a healthcare provider improves quality of life, improves patient outcomes, and decreases morbidity and mortality. This all adds up to improved health of our population.
Improving access to care in Michigan requires a multifaceted approach that addresses the geographic, economic, and regulatory barriers currently in place. Chronic diseases continue to pose a significant challenge, necessitating robust prevention and management strategies. Expanding the scope of practice for nurse practitioners could be a key strategy in enhancing healthcare access and addressing provider shortages, ultimately leading to better health outcomes for Michiganders.