Lenient NP scope-of-practice laws ease primary care shortage

Easing state guidelines limiting the scope of practice for nurse practitioners (NPs) can ease the impact of the shortage of primary care physicians, a study published in the journal Health Affairs found.

Nearly 3 percent of Medicare beneficiaries had an NP as their primary care provider in 2010, up from 0.2 percent in 1998, the study found. The percentage varied by state, from a low of 0.8 percent in Hawaii to 14.8 percent in Alaska. The rate of increase was greatest in states that allowed NPs to practice and prescribe without physician supervision.

Rates also varied by practice setting, with outpatient settings seeing the greatest proportional increase in NPs serving as Medicare patients' primary care providers.

The greatest growth occurred in states where NPs had independent prescription authority, regardless of the level of independence in other areas of their practice, according to the study. The degree of NP practice regulation accounted for 16.8 percent of the variation by state, the researchers found.

They noted that fewer than half of physician assistants practice in a primary care setting, limiting their ability to serve as a primary care provider.

Another Health Affairs study published last month found that while half of respondents to a survey preferred a primary care physician, 22.8 percent opted for a NP or a physician assistant, while 25.9 percent had no preference.

A majority also said they would rather see an NP or a PA sooner than a physician later, and liked the idea of spending less money to see a primary care provider.

But state restrictions on NP practices aren't the only barrier to having NPs fill part of the primary care physician shortage.

Results of a survey published this spring in the New England Journal of Medicine found that while 77 percent of NPs said their expanded role would reduce medical costs, only 31 percent of doctors agreed.

For more:
- here's the Health Affairs study abstract
- check out the NEJM study