California is among 23 states that allow nurse practitioners to act as primary care providers without a doctor's supervision, a move aimed at stemming a shortage of physicians and reducing costs. Now the nurses are poised to take on an even greater role as Los Angeles County and other health systems develop "medical home" models of care that expand the number of primary care providers, including nurses, to meet the requirements of national healthcare legislation, reduce unnecessary hospital visits and cut costs. Proponents say allowing such nurses to work as primary care providers can ensure that patients get quick, cheap access to care. But some doctors worry that the nurses overreach, doing more than they are trained to do.
