Despite Massachusetts’ reputation as a leader in health care reform, Commonwealth residents struggle to obtain adequate access to primary and specialty care throughout the state. The combination of limited patient access to care, an escalating opioid crisis and mounting healthcare expenses creates significant challenges. Other states, meanwhile, have moved forward in eliminating barriers that restrict nurse practitioner-led care.
While many states have worked to expand the role of NPs to address growing healthcare demands, Massachusetts remains hampered by outdated and overly restrictive licensing laws. The state ranks among only 13 nationally—and stands alone in New England—in maintaining such stringent nurse practice regulations. A consequence of health reform efforts has been expanded insurance coverage without corresponding improvements in actual access to medical services. Without policy changes to address this gap, conditions for Massachusetts patients are unlikely to improve.
The Commonwealth has access to 9,500 qualified Nurse Practitioners prepared to address its healthcare needs. These professionals hold licenses, board certification and advanced degrees at the master’s or doctoral level. Their documented track record of quality outcomes positions them to help close access gaps, improve care availability, provide treatment for opioid use disorder and reduce costs significantly. By failing to utilize NPs according to their full training and credentials, Massachusetts is overlooking a valuable resource for improving patient care.
For Massachusetts residents seeking routine healthcare—whether primary or specialty services—restrictive NP practice laws contribute to extended appointment wait times. Research demonstrates that patients in the Commonwealth face some of the longest delays nationally when trying to schedule new family medicine visits. Extended waits for care can lead patients toward worse health outcomes or push them toward costlier alternatives like emergency room visits.
Massachusetts faces the same opioid crisis affecting the nation. The MA Department of Public Health documented 2,155 opioid-related deaths in 2016. As overdose deaths involving neighbors, family members and colleagues continue mounting, all available tools must be deployed, including Medication Assisted Treatment (MAT), which saves lives. Nationally, NPs have played a significant role in treating opioid use disorder. In Massachusetts, however, outdated regulations requiring physician supervision of NP prescribing limit their effectiveness in responding to the epidemic. For patients with opioid use disorder, delays in accessing care can prove fatal.
A 2009 Rand Corporation study analyzing access and healthcare expenses projected that Massachusetts could realize substantial savings through expanded NP utilization. Despite these findings, the state has taken no action. NP office visits cost 20-35 percent less than physician visits while maintaining equivalent quality. Medicare, Medicaid and private insurers currently pay NPs at 75-85 percent of physician rates. As healthcare expenses continue rising, increased reliance on NPs represents a practical strategy for controlling costs.
Legislation now pending on Beacon Hill seeks to eliminate these practice restrictions. H.2451/S.1257, An Act to Contain Health Care Costs and Improve Access to Value Based Nurse Practitioner Care as Recommended by the IOM and FTC, would modernize state licensing requirements and establish Full Practice Authority for Nurse Practitioners, eliminating the physician oversight requirement for NP prescribing. This change would enable NPs to respond more effectively to the Commonwealth’s evolving healthcare needs. Greater access to primary care, specialty services and opioid use disorder treatment would generate significant savings for the state.
Nurse Practitioners, educated at the master’s or doctoral level and nationally certified in advanced practice specialties, possess the qualifications and expertise necessary to provide patients with high-quality, efficient healthcare.
Stephanie Ahmed, DNP, FNP-BC
Chair of the Massachusetts Coalition of Nurse Practitioners’ Legislative Committee and Former MCNP President
Donna Hanson, MS ANP, BC, MGH Emergency Medicine
Resident, Wintrhop, MA