A new report by Peter Buerhaus from the American Enterprise Institute provides a thorough review of the literature on nurse practitioners’ ability to provide primary care services and reaches an unsurprising conclusion: giving NPs greater scope of practice would be a boon to the U.S. healthcare system.
For the past few decades, the United States has not produced enough primary care physicians. Moreover, too few physicians practice in rural and medically underserved areas, and the number of people lacking adequate access to primary care has increased. Meanwhile, studies have piled up pointing to the high quality of care that nurse practitioners (NPs) provide, and increasing numbers of policy-influencing bodies have recommended expanding the use of NPs in primary care. Yet, barriers to the expanded use of NPs persist, and, consequently, tens of millions of Americans lack adequate access to primary care services.
Buerhaus’s findings can be lumped into four main groups.
Healthcare Costs: In states where NPs have broad scope of practice, healthcare costs are significantly lower. Treatment from PCNPs (primary care nurse practitioners) were 11 to 29% cheaper than similar treatments performed by PCMDs (primary care physicians). Expanded utilization of PCNPs would also save the taxpayer a significant sum, as Medicare pays NPs 85% of physician payments for the same services.
Increased Access: The geographic disparity in primary care providers makes “the problem…feel like a crisis.” In the U.S., there are 84 million people without adequate access to primary care, and 66% of the problem regions are in rural areas. While 63% of those living in states with greater authority for NPs had access to counties “with a high capacity of primary care clinicians,” that only holds for 34% of people in restricted scope-of-practice states.
NPs are also crucial for historically underserved populations. Compared to MDs, those who receive primary care from NPs “were significantly more likely to be female, younger, American Indian, nonwhite, dually eligible for Medicare and Medicaid (an important proxy for poverty), and qualified for Medicare due to a disability.”
Quality of Care: When analyzing the findings from studies related to Medicare beneficiaries, “[r]esults showed that when PCNPs cared for Medicare beneficiaries [they] had lower risk of preventable hospitalizations and emergency department use than those cared for by PCMDs,” in addition to other types of medical care.
Healthcare is a scarce resource, so preventing overutilization is a good way to trim the fat in our healthcare system. But, despite providing fewer tests and other procedures for patients, there is no evidence to suggest that scope-of-practice restrictions were related to the quality of care provided by PCNPs.
Physician Support of and Resistance to Increased Utilization of NPs: Interest groups for doctors, like those for most licensed professionals, have generally resisted expanded scope of practice for NPs. But the political opinions of PCMDs don’t quite line up with their professional opinions on the benefits of NPs. Almost 80% of PCMDs said PCNPs should be allowed to practice to the full extent of their education and only one-third thought it would decrease quality of care. One survey found that 57% of MDs worried their salaries would decrease, and about 75% thought they could be replaced by PCNPs, indicating that self-interest is a strong motivator to oppose greater utilization of PCNPs.
Update: This map mistakenly identified Oklahoma as a reduced practice state. It is in fact a restricted practice state. We apologize for any confusion, and here is an updated version of the map.