As the United States continues to face a devastating pandemic, rising healthcare costs, and a growing physician shortage, we need commonsense healthcare solutions to protect the public’s health. Although the politics of healthcare may seem intractable, there is actually a solution to both improve healthcare while lowering costs that is supported by politicians from both parties. It’s known as “scope of practice modernization” for nurse practitioners (NPs). Twenty-three states and D.C. allow NPs to practice to the full extent of their license and training, also known as full practice authority (FPA). Most recently, Massachusetts implemented FPA after witnessing the success of temporary expansion measures put in place during the COVID-19 pandemic. For 27 other states, the research is clear: nurse practitioner full practice authority is a win for patients, healthcare professionals, and healthcare systems.
In the U.S., 81 million people live in a primary care shortage area, most of which are rural areas. More than half of primary care physicians feel stressed due to time pressures at work. This problem will only continue to grow. The Association of American Medical Colleges projects a physician shortage of up to 139,000 physicians by 2033, up to 40% of which may be in primary care. The American Enterprise Institute argues that “it is unrealistic to rely on the physician workforce alone to provide the primary care Americans need, particularly for Americans in rural areas.” All of these statistics point to one truth: we need a larger, stronger primary care workforce to care for patients in the US. The evidence shows that physicians can’t do it alone.
AARP, which supports FPA as a means to expand access to care, includes in their policy book:
Primary care NPs are more likely to practice in rural areas, and significantly more likely to care for vulnerable populations. In its 2014 endorsement of removing scope of practice restrictions, the Federal Trade Commission noted that removing barriers to practice for NPs “can be one significant way to help ameliorate existing and projected access problems.” With over 290,000 NPs in the US (89.7% of whom are certified in primary care), and 30,000 more entering the workforce every year, empowering the profession to thrive is a cost-effective way to combat provider shortages in both rural and urban areas.
Not only do NPs provide high quality care, they also reduce cost burdens for both patients and the healthcare system. A 2015 study from Duke University found that implementing FPA in Pennsylvania would save the state at least $6.4 billion over the first 10 years after reform. Decades of research at both state and national levels have shown that when governments allow NPs to practice without unnecessary interference, healthcare costs go down.
These cost savings exist across the country and across care settings, but are even more evident in states with FPA. A 2017 study tracking changes in states as they implemented FPA found that “NP independence increases the frequency of routine checkups, improves care quality, and decreases emergency room use by patients with ambulatory care sensitive conditions.” The authors attribute these improvements to decreased administrative costs for physicians and a decreased indirect cost for patients accessing care, meaning that although lowered costs are a benefit on their own, they also enhance NPs’ ability to increase access to care.
Nurse practitioners provide high quality healthcare to a range of populations and in a range of specialties, including primary care. When NPs can practice to the full extent of their license and training, more patients benefit from the whole-person care NPs are trained to provide. A review of literature published on nurse practitioner and nurse midwife care over the course of 18 years found that outcomes were similar to, and, by some metrics, better than the outcomes of care provided by physicians alone. The authors state that “the results indicate that APRNs provide effective and high-quality care [and] have an important role in improving the quality of patient care in the United States.” A 2018 study of Medicare beneficiary data found that primary care NPs “had lower hospital admissions, readmissions, inappropriate emergency department use” than their other primary care provider (PCP) counterparts. A randomized control trial, the gold standard for hypothesis testing, found that patient outcomes for NPs and physicians in primary care did not differ. Put most succinctly by the American Enterprise Institute in 2018, “state-level NP scope-of-practice restrictions do not help protect the public from sub-par healthcare.”
While decades of data on patient outcomes compared to other provider types are significant, NPs also bring a unique set of skills and abilities to their practice. Both nursing school and NP graduate-level programs place significant emphasis on patient-centered, whole-person care that accounts for the effects of social determinants of health. Experience in this environment, at the bedside, and in the exam room prepares NPs to treat their patients holistically and in a broader context than just the symptoms they report.
Decades of research has shown that nurse practitioners provide high quality care to their communities at an affordable cost, often serving the most vulnerable patients. Increasingly, states recognizing this truth are removing barriers to practice for NPs and seeing even more positive results .
Author: MaryGrace Joyce, MS, is the Policy Specialist of the National Nurse-Led Care Consortium.
Twenty seven states continue to uphold unnecessary barriers to high quality, nurse-led care. Please visit our advocacy page for more information on the fight for full practice authority in legislatures across the country.