The trade group representing nurse practitioners in Michigan hopes updated state data showing high industry growth through the decade will spur action to expand the profession’s scope of practice.
Legislation introduced last fall and still sitting in a Senate committee would allow nurse practitioners to practice without having to secure a contract with a supervising physician.
Meanwhile, as the health care industry faces talent shortages across a number of professions, nurse practitioners recently ranked among the top “hot jobs” in the state’s latest employment outlook.
The ranking underscores the need to update the “antiquated” nurse practitioner law and meet evolving practices in health care, said Denise Soltow Hershey, president of the 2,000-member Michigan Council of Nurse Practitioners.
“We are hoping that it gives us some traction,” said Soltow Hershey, who’s also an assistant professor of nursing at Michigan State University and a practicing family nurse practitioner since 1995. “It puts a spotlight on the need and we’re No. 1 across all industries that are going to need people.”
Data from the Michigan Department of Technology, Management and Budget and Department of Labor and Economic Opportunity forecast the demand for nurse practitioners in the state will grow by more than 50 percent through 2030, or an average of 595 positions annually.
Michigan’s present law ranks as the 11th most restrictive in the U.S. for nurse practitioners, while 26 states allow them to practice at their full scope and without a contract with a physician, Soltow Hershey said.
“We do need to catch up with the times. It’s an antiquated law that needs to change,” Soltow Hershey said.
Based on the profession’s forecasted growth rate, nurse practitioners rank as the hottest of the state’s top 50 “hot jobs,” while six of the 10 professions expected to grow the fastest through 2030 are in health care.
Physician assistants ranked as the second-fastest growing job, at a forecasted 31.9 percent growth rate over eight years.
The growth in both professions reflect how physician assistants and nurse practitioners for years have assumed a greater role in primary care settings, particularly in wellness, heath prevention and managing chronic illness.
“We need our physician colleagues and we work collaboratively with our physician colleagues, but we can be that first stop for a lot of patients,” Soltow Hershey said. “The wave of the future is that nurse practitioners will be viewed as the primary care provider.”
The Michigan Health & Hospital Association is among the organizations backing the bill to fully open the scope of practice for nurse practitioners.
The association holds the view that “at a time when workforce challenges persist for many hospitals, this bill allows hospitals to choose the care delivery model that best fits their unique needs, including staffing resources and location, while maintaining safe and effective patient care,” said MHA CEO Brian Peters.
“We really believe that everyone ought to be encouraged and incentivized to work at the top of their profession,” Peters told MiBiz.
The Michigan State Medical Society believes otherwise and opposes Senate Bill 680.
Representing more than 15,000 doctors, the Medical Society has “serious concerns about this bill” and contends that “there is no evidence” that allowing for full independent practice of nurse practitioners will decrease cost of care, increase access to care, or improve quality of care, Chief Operating Officer Kevin McFatridge said via email.
“With the shift to value-based health care, a physician-led team of professionals, collaboratively working together to achieve optimal health outcomes for patients, must be the standard of care available to all Michigan residents,” he wrote. “Senate Bill 680 will move us from patient-centered team-based care to siloed care.
Debate over the bill comes amid shortages across many professions in health care and forecasted high growth rates for several jobs.
The latest outlook from the state for “hot jobs” reinforces health care’s role in Michigan’s economy, even with the shortage of workers in medical professions and across many industries, Peters said.
“This confirms what we’ve been saying for a long time, which is that health care is an economic engine for the state. We are one of the very largest employers, and certainly the largest employer in many communities throughout Michigan today, and that’s been true for some time,” Peters said. “When you look forward, and the pipeline issues that we have and where the supply and demand really comes into play, there’s no doubt that health care is going to be a place for job growth into the future.”
As of 2018, health care directly employed more than 600,000 people in Michigan and paid $39.1 billion in wages and salaries, according to the most recent economic analysis published by the MHA. More than 234,000 of those jobs were at hospitals.
Talent attraction and retention ranks as the top issue for the MHA, Peters said. As with most industries, health care providers face an acute worker shortage across clinical and non-clinical positions that worsened in the pandemic as many professionals opted to leave their position for another field or to retire.
Many hospitals report job postings going unfilled for months “because we simply can’t find the workers to fill those slots,” Peters said. Across the state, hospitals now staff 1,700 fewer beds today than prior to the pandemic.
“Go right down the line, whether it’s clinical or non-clinical, we are going to need more people in our hospitals and our health systems in Michigan,” he said. “We still have a real shortage in many particular areas of health care.”
The new state budget that takes effect Oct. 1 and recent supplemental spending bills direct $300 million towards addressing staffing shortages in health care, Peters noted.
In S.B. 680, lawmakers have an opportunity to provide another potential solution that can address the future demand for nurse practitioners, Soltow Hershey said. Changing the state law can help to retain nurse practitioners in Michigan, attract talent, and bring more people into the profession.
Many nurses who return to college to earn an advanced degree to become a nurse practitioner end up leaving the state, said Soltow Hershey, who teaches prospective nurse practitioners at MSU.
“Several of my students tell me, ‘I’m going to go look for a job elsewhere in a state where I can fully practice.’ We lose nurse practitioners to other states that have full practice authority already and don’t have that required contract,” she said. “And we don’t attract (nurse practitioners) to the state. They don’t want to come here because they have a more restricted practice.”