The state of California has been one of the earliest and most aggressive adopters of the Affordable Care Act. The desired outcome of the legislation is to reach into a population previously uninsured and provide health insurance for those individuals. On a macroeconomic basis, this translates into a larger pool of citizens with health insurance. This sudden increase in the “supply” of insured patients requires an increase in the number of physicians required to meet the new “demand”.

California has determined that only 16 of its 58 counties have the recommended number of physicians to support this new paradigm. The question looms large, how will California be able to meet the influx of new insureds after the Affordable Care Act is fully implemented?

As is the case in all market shifts, alternatives have already been afloat. Physician assistants, nurse practitioners, pharmacists, and even optometrists have expressed that their training affords them more knowledge than their license allows them to practice. This discussion is referred to as “scope of practice” issues and undoubtedly will lead to heated discussions across the country. This will ultimately become a state-by-state “turf war” with physician groups fighting to maintain control of the delivery of care while other licensed practitioners vie for expanded responsibility.

Keep an eye on California as it may tell us what role nurses will play in the future of healthcare delivery.