The Affordable Care Act, the FTC and the independent practice of nurses.

Although the intention of the Affordable Care Act (ACA) is to improve access to primary care for everyone, it also will increase the need for primary care practitioners. If Americans are going to achieve better health through preventive care and early intervention, there has to be a person properly trained and licensed to deliver and coordinate their care. This necessity for more “boots on the ground” is why the ACA supports nursing in many ways, including increased student loan availability;1 advanced nursing education grants that focus upon nurse practitioner and nurse midwifery programs;2 as well as student loan forgiveness, scholarships and loans to accredited nursing schools to foster the increase of the nursing faculty nationally.3 More controversially, the vision of the ACA seeks to do more than increase the nursing population, for the law alters how nurses—specifically advanced practice nurses (APNs)—will deliver patient care. No longer will APNs be providing patient care under a physician’s direction; in the post-ACA world, nurses—at least in some settings—will act as a patient’s primary provider, fully independent of any physician supervision. This concept of an expanded and less physician-centric, health care workforce will potentially be encouraged by a developing court case that was accepted on March 3rd for review by the U.S. Supreme Court. While on the surface it may appear to be unrelated, the outcome of North Carolina Board of Dental Examiners v. Federal Trade Commission (FTC)4 may have far-reaching implications for the independent practice of nurses in general and, specifically, the ability of state medical boards to limit the scope of their practice. The confluence of the ACA and the FTC will make 2014 a pivotal year in answering the decades-old questions of what role nursing will play in the health care delivery system of the future, and to what extent will physicians be able to regulate the practice of medicine?