By Justin Leventhal, American Consumer Institute
In many parts of America, getting basic medical care means long drives, longer waits, and not enough providers. Even in urban areas, appointment backlogs and ballooning costs make it difficult to see a doctor quickly. Meanwhile, tens of thousands of highly trained nurse practitioners and other advanced practice registered nurses (APRNs) are blocked from filling this need by outdated laws. Expanding their scope of practice isn’t radical—it’s the fastest, most cost-effective way to close the access gap, lower prices, and bring competition back to a system that desperately needs it.
In rural communities, doctor shortages translate into life-threatening delays and chronic gaps in care. Hospitals and clinics often struggle to hire and keep physicians, leaving entire counties without access to primary care, let alone specialists. This lack of coverage means patients must travel hours for routine visits if there is a doctor to see at all. The result is higher rates of death from preventable illness and chronic conditions—driven by a system that makes it too hard for qualified non-physician providers to step in.
In low-income urban neighborhoods, physician shortages compound existing health disparities and overwhelm already strained clinics. Even when facilities exist, residents often face weeks-long waits, limited hours, and bureaucratic hurdles that discourage timely care. Without enough providers, these communities see higher rates of emergency room use for non-emergencies and poor chronic disease management.
Empowering APRNs to practice independently would help fill these gaps, offering more flexible, affordable care where traditional physician supply can’t keep up.
While many states have already recognized the value of APRNs in addressing healthcare gaps, others are still catching up. Oklahoma recently began allowing all APRNs to apply for prescriptive authority, but only after completing 6,240 supervised hours—the equivalent of 780 eight-hour work days with no other tasks. While this is a step in the right direction compared to prohibiting prescribing entirely, nurse practitioners, midwives, and other APRNs have long demonstrated their ability to safely and effectively prescribe medicine. Oklahoma’s legislature should go further and remove the requirement altogether.
Other states are considering similar measures with Ohio’s proposed 5,000-hour requirement. Mississippi has introduced the same threshold, while another proposal in the state is slightly more reasonable, reducing the requirement to 3,600 hours. These proposals are better than Oklahoma’s law—and certainly better than prohibiting independent APRN practice—but they still impose needless restrictions. To become a certified nurse practitioner, midwife, or other APRN, nurses are already trained and tested. These additional hour requirements serve no real safety purpose; they simply protect physicians from more competition.
Michigan is considering a bill that would expand nurse practitioners’ scope of practice to include physical examinations, diagnostics, treatment, prescribing, and more—based on the training they already receive rather than arbitrarily determined time working under a physician. Where Oklahoma made a modest improvement, Michigan has the opportunity to make a leap forward and improve access to care in a state that ranks sixth in the number of Health Professional Shortage Areas. West Virginia is also moving in the right direction, expanding independent practice rights for both nurse practitioners and physician assistants, who also undergo rigorous advanced clinical training.
If passed, these bills would help Michigan and West Virginia open their primary care markets to more qualified practitioners than they had before. This expands competition into a sector that’s often insulated from it. When nurse practitioners, other APRNs, and physician assistants are empowered to operate independently, they offer patients an alternative to physician-dominated care that can be both more accessible and more affordable. This competition doesn’t just expand access—it puts downward pressure on costs by giving patients real choices and forcing providers to improve their service, reduce their price, or lose market share.
Scope of practice reform is not just about filling gaps in underserved areas; it’s a structural correction to a healthcare market that too often protects incumbents at the expense of patients. Letting more providers compete means lower prices, shorter waits, and care that works better for everyone.
Justin Leventhal is a senior policy analyst for the American Consumer Institute, a nonprofit education and research organization that advocates for consumers through evidence-based analysis and data. Visit www.TheAmericanConsumer.Org or follow on X @ConsumerPal.