The COVID-19 pandemic has strained the U.S. health care system and highlighted existing health care workforce shortages. In response, many states have tried to expand their workforce capacity to care for those with COVID-19. Most approaches that states have taken are consistent with guidance from the U.S. Department of Health and Human Services and the National Governors Association, and include actions like modifying provider scope of practice, recruiting retired or inactive providers and easing restrictions on telemedicine, among others. This edition of A Kansas Twist focuses on two of those approaches — modifying scope of practice and recruiting retired or inactive providers — and how they have been implemented in Kansas in response to the pandemic.
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Scope of practice issues, specifically regarding advanced practice registered nurses (APRNs), have been debated in the Kansas Legislature for many years. Most recently, two bills were introduced during the 2019 Kansas Legislative Session that would have allowed APRNs to practice without a collaborative practice agreement with a physician, sometimes referred to as “full” scope of practice. Although one of those bills — House Bill 2412 — was still alive at the start of the 2020 session, it did not receive a hearing or vote. Prior to COVID-19, Kansas was one of 28 states that require APRNs to have an agreement with physicians to independently manage patient care. As of June 19, 21 of those states — including Kansas — have temporarily suspended or waived practice agreement requirements, allowing APRNs full scope of practice during the pandemic. Multiple states, including Kansas, also have suspended supervision requirements for physician assistants (PA).
On April 22, Governor Kelly temporarily suspended statutes related to supervision, delegation and related issues for APRNs, PAs and other providers practicing in designated health facilities as part of the COVID-19 response in Executive Order (EO) 20-26. The provisions in EO 20-26 pertaining to supervision — including that APRNs can practice without physician supervision and PAs can practice without written agreements with a physician — were codified in Special Session House Bill (HB) 2016. These provisions remain in effect through January 26, 2021, at which point the Legislature could either allow these changes to lapse or re-implement them in new legislation.
States also have increased their health care workforces by recruiting retired or inactive providers back into practice, sometimes referred to as physician “re-entry.” The American Medical Association defines physician re-entry as “a return to clinical practice in the discipline in which one has been trained or certified following an extended period of clinical inactivity not resulting from discipline or impairment.” This could apply to physicians who have let their licenses become inactive for personal reasons, such as care taking or health issues. Prior to COVID-19, most states required physicians who wanted to re-enter the workforce to complete an assessment, which could result in physicians needing to complete additional education requirements through a re-entry program. Re-entry can be a long and time-consuming process with multiple barriers, including: few re-entry programs across the country, costs to complete re-entry programs and limited knowledge of the re-entry process.
As of June 9, 39 states — including Kansas — had expedited the process for inactive or retired physicians to receive licensure to assist in the COVID-19 pandemic. In Kansas, Governor Kelly issued Executive Order 20-08 on March 22, which created a temporary emergency license category. According to the Kansas State Board of Healing Arts, the entity responsible for licensing physicians in the state, individuals can qualify for an emergency license by meeting one of five criteria, including having held an active or exempt license in Kansas within the last two years, so long as the previous license was not revoked due to disciplinary action. The temporary emergency license category also was maintained in Special Session HB 2016 through January 26, 2021.
In addition to the changes described above, other efforts to address workforce shortages included early graduations for senior medical students at the University of Kansas Medical School. As COVID-19 subsides, it will be important to assess the impact of these efforts on the workforce itself, as well as the impact on access, quality and cost of care. Our April 2020 issue briefs on the primary care workforce (Defining the Primary Care Workforce in Kansas, Implications of an Aging Primary Care Physician Workforce in Kansas) describe the workforce shortage issues that existed in Kansas before COVID-19, as well as ways to combat them. Workforce shortages are unlikely to go away as COVID-19 subsides, and long-term policy solutions could be considered in future legislative sessions.