As New Jersey sunsets pandemic-era emergency orders, lawmakers are being asked to make permanent what was always meant to be temporary. During COVID-19, emergency waivers expanded scope of practice to address an extraordinary public health crisis. Those waivers also enabled the rapid growth of private businesses built on loosened supervision requirements. Now, as those emergency authorities expire, Senate Bill S2996 seeks to preserve and expand them. Legislators must be careful when present with this urgency-based rhetoric and look at the data. This rhetoric surrounding access to care is compelling, but the consequences of getting this wrong are severe and long-lasting.
As a triple board-certified physician practicing and leading in New Jersey, I care deeply about access to mental health care. It is the very reason I pursued physician administration and leadership. From hospitals to insurers to government, decisions made at the top of health systems have an enormous impact on patient outcomes. That power must be exercised carefully and guided by evidence, not urgency driven by expiring waivers or business disruption.
I work with nurse practitioners every day. I hire them. I value them. I could not maintain my role without them. However, I would not support hiring any clinician who is not committed to genuine collaboration. Nurse practitioners play an essential role on physician-led care teams, allowing us to extend care safely and efficiently when supervision, guidance, and shared accountability are present. Supporting that role is fundamentally different from removing physician oversight altogether.
Proponents of S2996 argue that independent practice will address provider shortages, particularly in underserved areas. However, multiple workforce analyses, including studies reviewed by the Federal Trade Commission and the American Medical Association, show that nurse practitioners, like physicians, tend to practice in already well-resourced areas. They do not disproportionately settle in rural or underserved communities, do not reliably enter shortage specialties, and have not been shown to meaningfully expand access for Medicaid patients. If access is the goal, the data does not support this approach.
More concerning is the effect on quality, utilization and cost. A large, multi-year study of Veterans Health Administration emergency departments published in Health Affairs by Mafi et al. examined outcomes when nurse practitioners practiced without physician supervision. The study found that independently practicing nurse practitioners generated approximately 7 percent higher emergency department costs, averaging $66 more per patient encounter. Emergency department length of stay increased by roughly 11 percent, and 30-day potentially preventable hospitalizations increased by about 20 percent. These findings reflected higher utilization of tests, imaging, and referrals without evidence of improved outcomes.
When applied to New Jersey, the fiscal implications are substantial. New Jersey emergency departments see approximately 3 million visits annually. If even 20 percent of those encounters were shifted to unsupervised nurse practitioner care, the added cost would approach $40 million per year for emergency care alone. This estimate does not include downstream costs from increased testing, longer stays, or preventable admissions, which would further strain patients, employers, insurers, and taxpayers.
Claims that there have been “no reports of harm” are misleading. Absence of formal reporting is not evidence of safety, particularly when adverse outcomes may be delayed, or never formally attributed to scope-of-practice decisions.
This issue surfaced clearly during prior executive orders expanding practice authority, when some nurse practitioners publicly acknowledged that they did not regularly communicate with their physician supervisors. That admission should have prompted serious enforcement and accountability. Instead of addressing this breakdown in collaboration, S2996 seeks to formalize independence, effectively sidestepping a patient safety measure rather than correcting it.
If supervision requirements are not being followed, the solution is not to eliminate them. It is to enforce them. True collaboration is bidirectional and requires accountability on both sides. Physicians must be available, engaged, and responsible supervisors. Nurse practitioners must practice within defined scopes and actively participate in collaborative decision-making. When that relationship functions as intended, patients benefit
The American Medical Association and other organizations have identified dozens of evidence-based strategies to expand access without compromising safety. These include collaborative care models, team-based practice, telepsychiatry, loan repayment programs, incentives for physicians and advanced practice clinicians to work together in underserved areas, and creating billing codes to account for supervision time appropriately. These approaches improve access while preserving the safeguards inherent in physician-led care teams.
My concern is not professional turf. It is patient outcomes. I spent over a decade, more than 18,000 hours training as a medical student, resident, and fellow to practice as a psychiatrist that works with adults, children and adolescents. By comparison, nurse practitioner programs require fewer than 1,000 clinical hours before reaching the same independent practice authority if this bill were enacted. I do not say this to boast. I say it because of the depth of training required to manage uncertainty, complexity, and risk in medicine. Even after that training, physicians understand that we do not know everything. Physicians learn, often painfully, that “you don’t know what you don’t know,” and how to use evidence-based systems to protect patients when stakes are high.
This does not mean physicians act alone. Medicine has never been a solo endeavor. But leadership in clinical decision-making matters, particularly in complex fields like psychiatry where missteps can have lasting consequences.
The passage of S299 would be a change to healthcare in New Jersey with irreversible consequence and without evidence of improving access or outcomes. Lawmakers should prioritize patient safety and evidence-based policy. Strengthening collaboration, enforcing supervision on both sides, and investing in proven access solutions will do far more for New Jersey patients than granting independent practice authority unsupported by data framed in urgency-driven rhetoric.
Dr. Adam Sagot is a triple board-certified psychiatrist specializing in general, child/adolescent, and forensic psychiatry. He is a board member of the New Jersey Psychiatric Association and Council on Advocacy Trustee.
