• Commentary

A Solution for Georgia’s Rural Healthcare Shortage

In a new study, the Georgia Public Policy Foundation proposes that the state allow physician assistants and advanced practice registered nurses, including nurse practitioners and certified nurse-midwives, to practice to the full extent of their education and training. This would address the lack of providers and overall access to healthcare throughout the state. In many parts of Georgia and the United States, it is almost a given that a visit to the doctor will include aggravating, and possibly dangerous, waiting periods. Many patients also have to travel long distances to reach their nearest care provider. 

As rural Georgia’s population declines relative to metropolitan areas, its problems stemming from healthcare disparities become more apparent and impactful. However, lack of access also affects significant portions of urban populations in cities like Atlanta, Augusta and Savannah. Geography, poverty, population demographics, Medicaid-eligibility and homelessness are a few of the factors that contribute to 149 of Georgia’s 159 counties being labeled Health Provider Shortage Areas (HPSA).

For perspective on how underserved Georgia really is, consider that nine counties do not have any kind of physician at all. Furthermore, 18 do not have a family medicine physician, 65 do not have a pediatrician, 82 do not have an OB-GYN, and 90 do not have a psychiatrist. Worse yet, physician licensing data in recent years demonstrates these disparities are widening.

Expanding full practice authority for healthcare professionals can help reverse this trend. Research shows that allowing physician assistants and nurse practitioners to operate independently and without physician supervision unlocks providers’ potential by improving access to quality care without exposing patients to new harm.

The positive effects of full practice authority are realized by vulnerable populations in particular. For example, it has been shown that granting full practice authority to nurse practitioners improves patient-reported mental health and reduces mental health-related mortality, especially in underserved areas. This is an especially important finding given the toll of COVID-19 lockdowns on American mental health and Georgia’s poor performance in mental healthcare access.

The access gap in rural Georgia would be especially helped by full practice authority, given rural areas’ troubling physician shortage. Research in other states showed that nurse practitioners, physician assistants and certified nurse-midwives are more likely to provide care to patients in rural areas and HPSAs. Furthermore, allowing full practice authority is associated with employment increases for nurse practitioners and physician assistants in rural areas and areas with physician shortages. Full practice authority is also associated with higher self-employment for nurse practitioners, which benefits economic development and employment.

Full practice authority also reduces the dollar amount of outpatient Medicaid claims while increasing the total days of care provided to Medicaid patients. It also gives Medicaid patients an overall higher likelihood of receiving treatment.

Expanding full practice authority for certified nurse-midwives would increase access for the additional Medicaid beneficiaries the state added by expanding postpartum Medicaid coverage. Georgia mothers earning up to 220% of the federal poverty level are now covered for a year after giving birth. States that allow full practice authority for nurse midwives show positive maternal health outcomes including lower rates of labor inductions and C-sections, as well as a slight increase in infant health metrics like birth weight and gestation when compared to states that restrict nurse midwives.

Critics of expanding full practice authority cite insufficient educational requirements and a lack of training and clinical hours among nurse practitioners. However, the master’s degrees required of nurse practitioners combine experience with years of training. They are also designed for specialties such as family medicine, women’s health and pediatrics– areas that would specifically address primary care access gaps in Georgia.

Another criticism is the notion that nurse practitioners will overprescribe opioids, however more recent studies demonstrate that full practice authority is not associated with an increase in opioid prescriptions.

If Georgia allows for expanded full practice authority, it will not be in uncharted territory. In fact, with Kansas’ decision earlier this year to expand full practice authority to nurse practitioners, Georgia and other states that still impose practice restrictions are in the minority. While full practice authority for physician assistants is not as common, two states have taken significant steps to reduce barriers for physician assistants, most recently with Utah in 2021.

In recent years, Georgia legislators have shown willingness to expand practice ability, but this effort has mostly been catching up with other states. Until 2020, Georgia was the only state that did not allow nurse practitioners to order non-emergent MRIs and CT scans. 

Full practice authority for nurse practitioners and physician assistants improves healthcare access, healthcare outcomes and cost with the added benefit of increasing healthcare to the populations in the most need. As other states deregulate, Georgia is falling behind. 

Click here to read the full report.