Scope of Practice for Reproductive Health: Assuring a Trained Medical Workforce in the Era of the Affordable Care Act

Hogan, Terry

Tuesday, June 10, 2014

International Ballroom

Terry Hogan, BA, MPH¹, Tynekua Smith, BA², Melissa Arbar, BSN, RN, MSN³, LaTrelle Scott, BS⁴, Cheryl Mason, MD, MPH⁵, Jeanne Hoover, BA², Arik Marcell, MD⁶, Daryn Eikner, BA, MS⁷, Anne Rompalo, MD, ScM⁸ and Robert McKenna, BA, MA, PhD⁹, 1Bayview Medical Campus, Johns Hopkins Univerisity, Baltimore, MD, 2School of Medicine, Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, 3School of Nursing, Johns Hopkins University, Baltimore, MD, 4Department of Education, Morgan State University, Baltimore, MD, 5Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 6School of Medicine, Department of Pediatrics, Johns Hopkins University, Baltimore, MD, 7Department of Service Improvement, Family Planning Council, Inc., Philadelphia, PA, 8School of Medicine, Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, 9Department of Training and Evaluation, Family Planning Council, Inc., Philadelphia, PA

Background: In 2010, the Male Training Center for Family Planning and Reproductive Health, a partnership between the Family Planning Council and the Johns Hopkins University conducted a survey of licensing boards to determine limitations to offering reproductive health services to males by providers (physicians [MD/DO], physician assistants [PA] and advance practice nurses [APRN]) offering specialty care to females. With the advent of the Affordable Care Act (ACA), that goal has expanded to determine if delivery of reproductive health overall is limited by practice. Our goal and the National Council of State Boards of Nursing (NCSBN) efforts to standardize APRN licensure intersect as both address practice.

Methods: From 2010 through 2013, the survey team contacted: 1) licensing boards for medicine, nursing and physician assistant in each of the fifty states and five federal territories; 2) specialty boards and certification bodies; and 3) professional agencies. Information was collected and collated by state and territory. In 2013, the data were reanalysed to determine limitations to offering reproductive health services overall.

Results: Physician practice is not limited by any state or territorial licensing board. For PAs, all fifty states and the three territories which recognize PA practice, limitations include supervision by and an agreement with a licensed physician. Limitations by nursing boards, however, are not consistent. As of September 2013, only seven states and one territory allow APRNs to practice as independent providers. One territory does not recognize the professional status of either APRNs or PAs.

Conclusions: In order to meet ACA requirements, all clinicians must practice at full scope of practice, which means APRNs must be able to practice as independent providers within their specialty. Unfortunately, the goal of the NCSBN to implement the Robert Wood Johnson/Institute of Medicine Report, “The Future of Nursing: Leading Change, Advancing Health” which promotes this scope has not been met.

WP 88 Scope of Practice for Reproductive Health: Assuring a Trained Medical Workforce in the Era of the Affordable Care Act