95 Indiana Law Journal 821 (2020)
The United States’ affordable care crisis and chronic physician shortage have
required advanced practice registered nurses (APRNs) and physician assistants
(PAs) to assume increasingly important roles in the healthcare system. The increased
use of these nonphysician providers has improved access to healthcare and lowered
the price of care. However, restrictive occupational licensing laws—specifically,
scope-of-practice laws—have limited their ability to care for patients. While these
laws, by themselves, have important implications for the healthcare system, they also
interact with other legal regimes to impact the provision of care. Restrictive scopeof-
practice laws can increase the malpractice liability risk of physicians and
decrease this risk for APRNs and PAs via several traditional tort doctrines, such as
respondeat superior. In this Article, I provide the first empirical analysis of the
interplay between malpractice liability and scope-of-practice laws in the provision
I concentrate on obstetric care and analyze a dataset of nearly 70 million births
over an eighteen-year period. The results demonstrate that relaxing APRN and PA
scope-of-practice laws significantly reduces the caesarean section rate—which is
currently over three times the rate recommended by the World Health
Organization—when malpractice liability risk is low. When malpractice liability risk
is high, however, relaxing these laws results in no change in the caesarean section
rate. I find similar results for other outcomes, such as medical inductions of labor.
The results thus elucidate an important interaction between scope-of-practice laws
and malpractice liability.
Based on this evidence, which shows that relaxing scope-of-practice laws can
significantly reduce the number of women who unnecessarily undergo major
surgery, I argue that states should eliminate restrictive scope-of-practice laws for
APRNs and PAs. Doing so will remove unnecessary limits on capable healthcare
professionals, better allow malpractice liability to deter the delivery of unsafe care,
and improve patient health outcomes.
"Healthcare Licensing and Liability,"
Indiana Law Journal: Vol. 95:
3, Article 5.
Available at: https://www.repository.law.indiana.edu/ilj/vol95/iss3/5