This is part two of our three-part series dedicated to the growth of the nurse practitioner profession. Be sure to check out part one and come back later this week to read part three. Within the next two years, experts estimate the Affordable Care Act will expand healthcare coverage to more than 32 million Americans. However, the supply of primary care physicians can’t keep up with the increase in access.
The American Academy of Family Physicians estimates that the United States faces a shortage of 60,000 primary care physicians overall by 2020. Luckily, the NP profession has roots in primary care and family practice. Of the licensed NPs currently working in the US, 80% are prepared in primary care focus. Also the number of practicing NPs is on the rise. A recent study conducted by David Auerbach estimates there will be an additional 87,000 NPs practicing in the United States by 2025.
NPs are willing and capable to deliver primary care services that and have demonstrated the ability to deliver outcomes equal to physicians. Although their education is structured differently than physicians, NPs have either completed a master’s or doctorate program, making them qualified to manage illnesses, interpret diagnosic and laboratory tests, prescribe medications, and perform physical exams. “There is a growing gap and huge need that makes anyone in the primary care space more desirable,” says Mary Jo Goolsby, Director of Research & Education at the American Academy of Nurse Practitioners (AANP).
“Primary care is an area where NPs continue to grow as compared to other disciplines. Fewer and fewer are entering into primary care, but that’s not the case for NPs.”
Many healthcare reform initiatives focus on providing patient-centered care and chronic disease management to individuals who are to new healthcare consumers. “With their established patient-focused approach, NPs are ideally suited for this type of practice,” Goolsby says. In fact, many see NPs as the key ingredient needed to manage the primary care shortage, particularly in rural areas that are hit hardest. About 20% of Americans live in rural areas, but only 9% of physicians practice there, according to Dr. Howard Rabinowitz, a professor of family and community medicine at Thomas Jefferson University’s Medical College. On the other hand, NPs are flourishing in rural areas. According to the AANP, NPs are more likely to practice in rural communities than any other primary care discipline.
Many NPs have established successful nurse led community centers in rural and underserved areas. “Part of the nursing model is to reach out to populations that are not served well by the current healthcare system,” Michelle Perron Pronsati, Editor for ADVANCE for NPs and PAs, explains. “NPs tend to be more open to those practice opportunities.” Although their education and experience makes them capable of practicing autonomously, state law dictates how independently NPs can practice. In 16 states (Alaska, Arizona, Colorado, Washington, Hawaii, Idaho, Iowa, Maine Montana, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, Vermont, and Wyoming) and the District of Columbia, NPs have plenary authority, which means that can practice as an independent provider. The 34 remaining states require NPs to either collaborate or be supervised by a physician. The AANP works with NP representatives in each of those states to lobby for more modern scope of practice laws, says Tay Kopanos, DNP,NP, Director of Health Policy, State Government Affairs for AANP.
“Our role is to look at the legislative and regulatory landscape and see how can we help ensure that patients get direct access to the expertise an NP can provide. We are actively working with states to modernize their state practice laws and regulations,” Kopanos says. In addition to licensure requirements, states may also dictate whether NPs can do the following:
- Prescribe drugs
- Sign handicapped parking permits
- Order physical therapy
- Recognize as primary care providers
- Sign death certificates
- Sign workers’ compensation claims
View our interactive graphic that shows the state laws for each of those categories. Complementing, not competing NPs were originally thought of as physician extenders or mid-level providers, Dahring says. However, most NPs oppose the use of such terms because they are not definitive of their role or abilities. Studies have shown that NPs provide a standard of care equal to physicians and other healthcare providers. In fact, an article that appeared in the April 2010 issue of the Journal of the American Academy of Nurse Practitioners stated that “of more than 100 published, post-OTA reports on the quality of care provided by both nurse practitioners and physicians, not a single study has found that nurse practitioners provide inferior services within the overlapping scopes of licensed practice.” The difference between what conditions a physician can treat and what a NP can treat comes down to 5%.
According to estimates, family practice physicians can treat 90% of the conditions that come through the door, while NPs are able to treat 85%. That 5% that physicians can perform includes procedures such as circumcision and vasectomy, according to Kopanos. In many cases, primary care physicians, although qualified, do not perform such procedures as frequently as a specialist. When it comes to more common primary care services such as managing illness, prescribing medications, and performing physical exams, there is a lot of overlap with what the NPs and physicians can do. Although NPs provide many of the same services at a level that is equal to that of a physician, Dahring says physicians should not see NPs as competition.
“It is not our goal to take patients away from MDs any more than specialists are trying to undermine family practice,” Dahring says.
Kopanos agrees and says that arguments that NPs may drive physician practices away from the state or reduce physician salaries are baseless. In fact, studies have shown physician salaries are on par and in some cases better in states that have modernized their NP scope of practice laws. More importantly, states that allow NPs and other non-physician providers the ability to practice to the top of their education are better prepared to implement integrated healthcare systems and provide comprehensive care to their citizens.
