1. Kaplan, Louise PhD, ARNP, FNP-BC, FAANP

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The Federal Trade Commission (FTC) issued a policy paper in March that provided an analysis supporting nurse practitioner (NP) advocacy efforts for unrestricted practice. The FTC is authorized to prevent unfair methods of competition and unfair or deceptive acts affecting commerce.1


The FTC has focused on anticompetitive actions in healthcare-a major portion of the U.S. economy-for quite awhile and has supported NP advocacy in the past. For example, in 2011, the FTC sent comments regarding Florida House Bill 4103, which, had it passed, would have removed some of the constraints on supervisory arrangements between physicians and advanced practice registered nurses (APRNs). The FTC noted that the bill represented a procompetitive improvement in the law and was likely to benefit Florida healthcare consumers.2


The recent FTC paper, Policy Perspectives: Competition and the Regulation of Advanced Practice Nurses, includes background information on APRNs and scope of practice issues.3 It also includes APRN scope of practice competition advocacy comments noting the potential benefits of improved competition in the provision of healthcare services. The paper describes the potential competitive harms in states where APRNs are required to be supervised by physicians.


There are several principles the FTC urges legislators and policy makers to consider when analyzing proposed changes to APRN scope of practice.3 Among them are:


* Potential competitive effects can be especially striking where there are shortages of primary care providers, such as in medically underserved areas or with medically underserved populations. APRNs can more effectively fulfill unmet healthcare needs when undue practice restrictions and supervision requirements are removed.


* APRNs typically collaborate with other providers. Effective collaboration between APRNs and physicians does not necessarily require direct physician supervision of APRNs or a fixed model of team-based care.


* APRN scope of practice limitations should be narrowly tailored to address well-founded health and safety concerns and should not be more restrictive than patient protection requires. Otherwise, these limitations can deny patients the benefits of competition.



The paper concludes with the following statement:


Numerous expert health policy organizations have concluded that expanded APRN scope of practice should be a key component of our nation's strategy to deliver effective healthcare efficiently and, in particular, to fill gaps in primary care access. Based on our extensive knowledge of healthcare markets, economic principles, and competition theory, we reach the same conclusion: expanded APRN scope of practice is good for competition and American consumers.3


While the policy paper advocates for elimination of unnecessary restrictions to promote competition, it does not come out unequivocally in support of full, unrestricted practice authority. The FTC concludes that:


When faced with proposals to narrow APRN scope of practice via inflexible physician supervision and collaboration requirements, legislators are encouraged to apply a competition-based analytical framework and carefully scrutinize purported health and safety justifications. In many instances, legislators may discover that there is little or no substantiation for claims of patient harm. If, however, health and safety risks are credible, regulations should be tailored narrowly to ensure that any restrictions on independent APRN practice are no greater than patient protection requires.3


The FTC policy paper can assist NPs who advocate for regulatory changes to eliminate unnecessary restrictions. Numerous studies provide evidence of high-quality NP care and serve as testimony to the fact that restrictions on NP practice are unnecessary.




1. Federal Trade Commission Act, 15 U.S.C [S]45. [Context Link]


2. Federal Trade Commission. Florida bill that would ease physician/nurse practitioner supervisory requirements would benefit states health care consumers. 2011. [Context Link]


3. Federal Trade Commission. Policy perspectives: competition and the regulation of advance practice nurses. 2014. [Context Link]