The NCSL Blog


By Sydne Enlund

In areas where there are not enough doctors and nurses to keep up with the demand for their services—such as rural and underserved urban areas—state legislators are broadening the roles of some licensed health professionals through “scope of practice” laws.

Scope of practice logoSupporters say that expanding the authority of nurse practitioners, physician assistants, dental hygienists, and other oral health providers to perform additional procedures, treatments and actions would help alleviate health workforce shortages.

Legislators have considered dozens of bills over the past several years. New Jersey lawmakers, for example, voted last year to allow greater flexibility in the way physician assistants provide care. They removed the requirement that a physician must always be present and allowed the physician assistant to work with a physician to define his or her personal scope of practice. Maryland and Nebraska passed legislation in 2015 to allow nurse practitioners to practice without physician oversight.

Proponents of these laws say li­censed professionals can be trained quicker and less expensively than physicians without compromising quality. Some physician groups disagree and argue that physicians’ longer, more intensive training equips them to diagnose more accurately and treat patients more safely. Scope of practice bills often bring out passionate advocates with different points of view.

For those interested in more information, there’s a new website created by NCSL and the Association of State and Territorial Health Officials that focuses on scope of practice policies for nurse practitioners, physician assistants, dental hygienists and dental therapists in all 50 states, D.C. and the territories.


Primary Care Health Professional Shortage Areas

Health professional shortage area map













Legend: HPSA Score

               Light Green: 1-13

               Middle Green: 14-17

               Dark Green: 18 and above

               White: Non-HPSA

Scores range from 1 to 25. The higher the score, the greater the priority.

Source: Health Resources and Services Administration Data Warehouse

State Legislation tracked on












Source: Scope of Practice Policy


                                                                                          Rural      Urban

Primary Care Doctors Per 100,000 people              40           53

Nurse Practitioners Per 100,000                              28           36

Physician Assistants Per 100,000                           23           34

Dentists Per 100,000                                               22           30

Specialists Per 100,000                                          30           263

Population Over Age 65                                         18%       12%

Sources: Health Resources and Services Administration and Rural Health Information Hub, 2016.

Sydne Enlund is a research analyst in the NCSL Health Program.

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About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.