By Adam Rubenfire

Maryland has become the 21st state in the union to allow nurse practitioners to practice independently of a physician.

Gov. Larry Hogan signed the Nurse Practitioner Full Practice Authority Act this week. The measure allows nurse practitioners to prescribe certain drugs without having an "attestation agreement" with physicians. Maryland follows Nebraska, which enacted a similar law in March, and Minnesota, which passed legislation last year.

In addition to being free of collaborative agreements, an independent nurse practitioner would be able to open up his or her own clinic. Some nurse practitioners have to make payments to doctors to form collaborative agreements.

State medical societies have often expressed concern about full-practice authority legislation, arguing that nurse practitioners aren't able to provide the same quality of care as a licensed physician, and therefore need to work under one. Proponents say nurse practitioners can assist patients during the current shortage of primary-care physicians. The sides seemed to have compromised in Maryland, where the state medical society did not oppose the finished bill.

The society, initially asked that legislators amend the initial bill to require that less-experienced practitioners should enter a collaborative agreement, similar to how others states, including New York, handle the situation. The doctors also wanted the law to allow for the discipline of nurse practitioners who fail to refer to or consult a physician when necessary.

With those two amendments in place, the organization no longer opposed the bill, said Gene Ransom, the organization's CEO.

“I think the Legislature here did a pretty good job moving the bill in a new direction,” Ransom said. “This is not a nurse vs. doctor thing. We're all a part of the healthcare team.”

Ken Miller applauded the legislation, arguing that states that give nurse practitioners more authority are improving access to healthcare as a result.

"The legislative leadership we've seen in states like Maryland illustrates how lawmakers are increasingly rallying behind nurse practitioners as essential providers, especially equipped to meet the healthcare needs of constituents," Miller said in a statement. "We urge all states considering similar legislation to champion this tried-and-true, no-cost healthcare solution that is gaining momentum all throughout the nation."