We are undeniably in a worsening crisis of health care access, one that will likely get worse in the coming years as federal insurance subsidies end. We must confront the crisis directly and effectively.
One proposed solution would allow nurse practitioners to diagnose, treat, and prescribe medications without a collaborative agreement with a physician. Supporters of the bill argue that giving nurse practitioners full practice authority will expand access to care, especially in rural areas, while reducing costs and removing unnecessary red tape. These claims sound reasonable, but they overlook the real barriers that keep Pennsylvanians from getting the care they need.
Other states have adopted similar laws, yet their rural communities still face severe shortages. Data from the American Medical Association show that nurse practitioners and physicians tend to work in the same areas regardless of scope-of-practice laws. States like California and Texas granted full practice authority years ago, but their rural regions remain underserved. The problem is not collaboration; it is the lack of infrastructure and financial support that makes rural practice unsustainable.
Hospitals and small practices across Pennsylvania are struggling to stay open because reimbursement rates from public insurers do not cover the cost of care. According to the Center for Rural Pennsylvania, more than a quarter of the state’s rural hospitals are at risk of closure. When a hospital shuts down, the loss ripples across the community. Emergency rooms close, primary care offices and specialty clinics disappear, and patients are left without any coordinated system of care. These systemic failures cannot be solved by changing scope-of-practice rules.
While some may frame physician collaboration as a barrier, it is one of the critical safeguards that ensures patients receive coordinated, comprehensive care. When multiple clinicians are involved in a patient’s treatment, collaboration ensures clear communication, accountability, and continuity. It prevents the fragmented care that can lead to medication conflicts, redundant tests, or missed diagnoses. Oversight is not about limiting anyone’s role; it is about maintaining a level of coordination that protects patients and supports better outcomes.
Expanding independent practice sounds like a quick fix, but it risks creating a patchwork system with uneven standards. Access without coordination is not progress and it violates the spirit of teamwork that improves health care outcomes. Patients in rural and underserved areas deserve the same quality of care as those in major health systems, not a separate standard based on geography. True access is about ensuring that every patient has consistent, reliable care from a team that communicates and works together.
The solutions that would actually strengthen Pennsylvania’s health care system are well known: expanding telehealth would bring physicians and specialists to patients wherever they live; increasing loan repayment programs and rural residency opportunities would encourage more doctors to practice in underserved areas; ensuring fair reimbursement for hospitals and clinics would stabilize the infrastructure that keeps communities healthy. These measures require investment, but they create long-term results rather than temporary fixes. Our health is simply worth the investment.
Our rural issue is not who provides care, but how we sustain care across an entire system that is under strain. Removing oversight will not bring new providers to rural towns or keep hospitals open. It will only weaken the team-based structure that gives patients confidence their care is safe, consistent, and coordinated.
Pennsylvania’s lawmakers should focus on strengthening the system, not dismantling it. Patients deserve access to care that is available when they need it and guided by a coordinated team that works together to deliver the best possible outcomes. That is the foundation of safe, effective, and sustainable health care but band-aid solutions put it at risk.
This Op-Ed was submitted in response to an Op-Ed that ran in the October 17, 2025 edition
This Op-Ed was submitted in response to an Op-Ed that ran in the October 17, 2025 edition