As in many states across the country, Missouri is sorely lacking in basic suppliers. An additional 687 PCPs are expected to be needed by 2030, which is an important task considering that many medical students in the state choose to practice elsewhere after graduating due to the glaring lack of residency places. The short answer is obsolete legislation. Despite overwhelming evidence that PRs provide safe, quality, and inexpensive health care, Missouri nurses work under “restricted practice conditions.” According to the Missouri Board of Nursing, PNs must have a Collaborative Practice Agreement (CPA) with a physician in the state. This means that no matter how much training and experience a NP in Missouri is, that person must be “monitored” by a doctor within 50 miles, who receives money to sign the most common treatments and prescriptions on his own. (Until April 2018, the maximum distance was 30 miles.) If the only doctor within 50 miles of a clinic he or she supervises decides to retire, all health operations managed by the NP will be closed until they can find another doctor to sign their forms. Dr. Hemmer kindly offered his perspective on practical autonomy in Missouri. The following interview was handled easily. With many baby boomers seeking more medical services and a growing health crisis looming on the horizon, Missouri lawmakers are encouraged to make the right decision and expand quality and affordable access to health care for their residents by expanding practice privileges to PNs. Although collaborative practical agreements are defined in point 334.104.2, RSMo as written agreements, jointly agreed written protocols or permanent written contracts for the provision of health care, advanced nurses often provide written agreements with cooperating physicians. Instead of listening to lobbyists from the Missouri State Medical Association – the only institution that tries to systematically deny PNs the right to full practice privileges because they will lose money – should local legislators and citizens turn to the countless groups that have defended the full autonomy of PNs across the country, including: Have you ever felt limited by the laws on the practice of NP in Missouri? It should be taken into account that the requirements inherent in the above-mentioned statutes and state rules with respect to advanced practice in registered nursing and collaborative practice may need to be linked to the requirements of other relevant state or federal laws and rules. .