Pa. Medical Society reacts to Senate passage of SB25

Last Updated: Jun 12, 2019

The following is a statement from Danae Powers, MD, president of the Pennsylvania Medical Society (PAMED). She reacts to passage of Senate Bill 25, which would eliminate the requirement that certified registered nurse practitioners (CRNPs) have a collaborative agreement with physicians. SB25 now moves to the Pa. House.

While we share the goal of improving access to care in rural and underserved areas, the Pennsylvania Medical Society vigorously disagrees with Senate Bill 25 as the solution.

If collaborative agreements impede CRNPs from moving to rural areas, as supporters of Senate Bill 25 seem to suggest, why are states that don’t require collaborative agreements with CRNPs still struggling with how to tackle access-to-care issues?

For example, Arizona has not required CRNPs to have collaborative agreements since 2001, yet only 11 percent of all non-physicians (CRNPs, physician assistants, certified nurse midwives) work in rural areas and serve only 15 percent of Arizona’s rural population. A similar study in New York suggests there are more nurse practitioners in urban areas per 100,000 population than in rural areas.

According to the AMA’s workforce map, Pennsylvania already has a higher number of CRNPs working in the state’s 10 least populated counties compared to Arizona, West Virginia, Maryland, and New Mexico – all states in which CRNPs do not need a collaborative agreement with physicians.

If Pennsylvania lawmakers truly want to address this issue, more effective measures include supporting current legislation that expands telemedicine services and increasing state funding for physician residency programs.

Senate Bill 25 calls for CRNPs to work without a collaborative agreement after only 3,600 hours of experience – that’s coupled with about 500-750 hours of education and training. Compare that to the 12,000 to 16,000 hours of education and training that physicians need to practice independently.

Expanding the scope of nurse practitioners has been championed as a way to decrease health costs. But studies have shown it may actually increase the cost of care due to CRNPs making poorer quality referrals to specialists, ordering more diagnostic imaging studies, and writing more prescriptions than primary care physicians.

Pennsylvanians living in rural and underserved areas deserve equal access to quality care, which I believe involves physicians and CRNPs working together. Senate Bill 25 does the opposite.

PAMED thanks Senators Patrick Brown, Jake Corman, John Gordner, Kristin Phillips-Hill,  Mike Regan, Kim Ward for their opposition to this bill.

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Studies referenced above
1. Comparison of the Quality of Patient Referrals From Physicians, Physician Assistants, and Nurse Practitioners. Mayo Clinic:  
2. A comparison of diagnostic imaging ordering patterns between advanced practice clinicians and primary care physicians following office-based evaluation and management visits. JAMA Internal Med:
3. Prescribing Practices by Nurse Practitioners and Primary Care Physicians: A Descriptive Analysis of Medicare Beneficiaries. Journal of Nursing Regulation: 

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The Pennsylvania Medical Society helps its 20,000 physician and medical student members return to the art of medicine through advocacy and education. Learn more by visiting or by following us on Twitter at @PAMEDSociety.

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