Jamie Gallagher is a Doctor of Nursing Practice and a board-certified Family Nurse Practitioner in North Carolina. She has nearly 32 years of experience as a registered nurse and 17 years as an advanced practice provider.
She has worked in primary care, urgent care, and women’s primary care, which is where she encountered an unmet need: healthcare tailored to midlife women. Jamie began specializing in perimenopause and menopause but wanted more time with her patients than working under a big healthcare organization would allow. So she opened her own practice, Peri & Pause. It took off so quickly that she opened two locations within a year and is currently making plans for a third.
In North Carolina, however, nurse practitioners (NPs) are prohibited by law from working without contracting with a physician—even though the state already requires them to demonstrate competence in diagnosing patients, interpreting diagnostic tests, managing treatments, and prescribing certain medications as a condition of their licensure.
This so-called collaborative practice agreement (CPA) mandate is costly for NPs like Jamie, who own their own practices. Because the state has already vetted her qualifications through licensure and national certification requirements, the CPA mandate does nothing to advance patient safety—but it does advance the economic interests of collaborating physicians, including those she might compete against as an independent practitioner. It also results in higher costs and provider shortages for patients seeking care, particularly in rural areas already short on physicians.
Jamie pays $16,500 per year for a CPA that covers herself and four of her nurse practitioners. Her collaborating physician is not required to review her charts or meet with her patients. Nor is he required to be on site where Jamie provides care. North Carolina only requires him to sign her paperwork.
As Peri & Pause continues to grow, Jamie needs to hire more NPs. But her current collaborating physician won’t work under a collaborative agreement with any additional NPs she hires—meaning Jamie needs to enter into another expensive agreement with another physician if she wants to expand her business.
“Every midlife woman needs some form of this type of care,” she says. “And if we’re able to give it while it’s still kind of a desert nationwide, then I feel this strong obligation to continue to grow as fast as I can within reason.”
With the help of Pacific Legal Foundation, Jamie filed a lawsuit challenging North Carolina’s collaborative practice agreement as unconstitutionally burdensome on nurse practitioners’ right to practice free of arbitrary restrictions.
Her complaint alleges that because NPs are fully licensed and certified healthcare providers, North Carolina’s requirement is costly, redundant, and does nothing to advance patient safety. By virtue of their training and licensure, the state has already deemed NPs qualified to provide care. Additional burdens violate the Fruits of Their Own Labor, Law of the Land, and Equal Protection Clauses of the North Carolina Constitution.
After building a practice around an underserved need, Jamie’s lawsuit argues that North Carolina’s law is standing between patients and the care they are seeking.
“You do not have to force nurses to collaborate,” she says. “And signing a piece of paper twice a year is not collaboration.”
What’s At Stake?
- A license to practice should reflect what a provider is trained and qualified to do—not what established competitors are willing to allow. Laws that prevent qualified professionals from practicing to the full extent of their training deprive them of the right to work and patients of needed care, especially in North Carolina, where 93 out of 100 counties are Health Professional Shortage Areas.
