Freakonomics: Nurses to the Rescue!

November 15, 2017
By Stephen J. Dubner & Produced by Greg Rosalsky

ROSALSKY: But as the profession grows, it’s facing legal and political challenges from state governments. In most states, NPs have had to fight to obtain a license that would give them what’s known as “full-practice authority,” letting them provide all the services they’ve been trained and certified to deliver. In California, for instance, they’ve been on the losing end of this fight. Surani Hayre Kwan again:

KWAN: We’ve now had three full-practice authority bills that have all failed.

ROSALSKY: So what’s the problem? To figure it out, I decided to drive up to the state capitol, in Sacramento. After passing through metal detectors and security, I made it to the office of Senator Ed Hernandez.


Greg ROSALSKY: Hey, how’s it going?

ROSALSKY: Hernandez represents the San Gabriel Valley, just east of Los Angeles.

HERNANDEZ: So, by profession, I’m an optometrist. Been one for 30 years, been involved in politics pretty much my whole life. Became an activist, was concerned about health care in the state. How individuals didn’t have access. Decided to run in ’06; got elected. Now I’m in the Senate and been chair of the health committee and I’ve been honored to be a public servant.

ROSALSKY: One of the first big things Hernandez did after getting elected was to form a select committee that analyzed the medical workforce of the state.

HERNANDEZ: We found out there was a huge shortage of primary-care providers but not only was there a workforce shortage, but there was a huge distribution problem of where primary-care providers go to.

ROSALSKY: Where they didn’t go to was California’s rural areas — a trend that holds true in many other states as well. The National Rural Health Association says that a quarter of the U.S. population lives in rural regions, but only 10 percent of physicians actually practice there. There’s a similar shortage in low-income urban communities. In both cases, doctors are reluctant to accept the low reimbursement rates of government-funded health programs. Hernandez wanted to do something about these primary-care shortages. One option would be to get more doctors into the system. But it turns out that’s really difficult. For one thing, Hernandez says, there’s limited capacity at U.S. med schools. Of the 53,000 students who applied for admission in 2016, 32,000 were rejected from all the schools they applied to. That’s sixty percent of all applicants.

HERNANDEZ: So we have a finite number of medical schools, whether it’s in California or across the country. And they’re not growing in leaps and bounds. The biggest hurdle is obviously the costs.

ROSALSKY: There’s also the time and money it takes to become a doctor: four years of undergrad, four years of med school, and then a residency of three to seven more years.

HERNANDEZ: There’s at least 12 years before they’re out in the work force.

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