Since Gov. Kathy Hochul appointed me New York State Health Commissioner, I have been meeting with leaders of struggling hospitals and nursing homes around the state. From Far Rockaway to the North Country to Buffalo, all have told me the same thing: They have remarkable workers, but the costs of hiring and retaining qualified staff are unsustainable and their workforce options are limited. 

The New York State Legislature can help solve this problem by passing common-sense expansions to the duties health care workers are allowed to perform under their license, known as their scope of practice.  

This is how NY wrongs our health care workers

Many of New York’s scope of practice laws are much more restrictive than those in other states. As I reflect on my time thus far as Health Commissioner, I have yet to see evidence that these restrictions serve our patients better than these other states. In fact, I am concerned our outdated, bureaucratic standards make it more difficult for patients to receive the care that they need and deserve in New York State. 

For example, New York is the only state that does not allow a medical assistant to administer a vaccine — even though we just emerged from a pandemic when even unlicensed individuals could give you a COVID-19 vaccination due to the temporary expansion of scope of practice.  There is no reason medical assistants should not be able to administer vaccines with adequate supervision and training even when we are not in a national emergency.  

Thirty-eight states are getting nurses back to the bedside by allowing certified medication aides to administer basic medications in nursing homes. New York does not — even though assisted living facilities in the State allow for them, and medication aides are authorized in facilities operated by our sister agency, the Office for People With Developmental Disabilities. How does this serve timely patient care when nursing homes face staffing challenges? 

New York allows nurse practitioners with sufficient training to practice independently in certain settings, but not physician assistants. Hochul is proposing physician assistants receive 8,000 hours of training that would then allow physician assistants to practice independently — this change will greatly contribute to addressing health care workforce challenges in hospitals and will help increase timely access to primary care providers, particularly in rural New York. 

New York’s Community Paramedicine pilot program has proven to be successful in expanding the role of EMS providers as part of coordinated care teams, delivering in-home assessments, treatments and pathways that help patients receive timely support while reducing unnecessary visits to already crowded emergency departments. Expanding this program will allow more EMS agencies to participate, strengthen local health care delivery models and ensure that communities across New York State have greater access to the right care at the right time. 

New York's Legislature must act

Hospitals and nursing homes are asking for higher reimbursement, and New York has made significant investments in funding increases. However, rules requiring that advanced practitioners do tasks which others can safely perform are a major cost driver that has not been addressed. These ongoing costs are unsustainable. 

As the federal government continues to slash health care, we must use every tool available to modernize our workforce policies. I urge the Legislature to include the governor’s proposed scope of practice reforms in the final budget.

Dr. James McDonald is New York State Health Commissioner.

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