New study estimates only half of nurse practitioners practice primary care

Increasing numbers of nurse practitioners are entering higher-paying specialties instead of primary care, according to a one-page policy brief published in the American Family Physician.

Researchers from the AAFP’s Robert Graham Center for Policy Studies in Family Medicine and Primary Care analyzed nurse practitioner and physician assistant national provider identifier (NPI) numbers in order to determine whether they delivered primary care. Each NPI number has an associated clinical location. The researchers calculated the number of primary care nurse practitioners based on the assumption that nurse practitioners who worked independently or at a location with a primary care physician were primary care providers. Their analysis resulted in an estimate that 52% of nurse practitioners (55,625) provided primary care services.

The number is a bit of a surprise because it is much lower than the number of nurse practitioners who are trained in primary care. The American Association of Nurse Practitioners estimates that 89% of nurse practitioners “are prepared in a primary care focus; e.g. adult family, gerontological, pediatric, or women’s health.” The new research suggests that while many nurse practitioners are trained in primary care, a significant percentage choose to pursue a specialty after graduation. Andrew Bazemore, M.D., M.P.H., director of the Graham Center, said in an AAFP press release, “This is similar to the pattern of physicians entering residency in internal medicine or pediatrics at the end of medical school who go onto further training and practice in subspecialties.”

In fact, a recent study found that only 22% of internal medicine residents plan to practice general internal medicine. In response to the findings, the AAFP recommends instead of relying on nurse practitioners and physician assistants to make up for the shortage of primary care physicians, policymakers should continue to develop policy solutions designed to increase the number of primary care physicians, nurse practitioners and physician assistants.