Primary care is in high demand, but the ongoing physician shortage leaves plenty of access gaps.
One solution? Harnessing the skills of nurse practitioners in underserved areas, according to a new report from the American Enterprise Institute.
The dearth of primary care doctors, particularly in rural and remote regions, is only projected to get worse, according to the report. The Association of American Medical Colleges estimates that the healthcare system will be short 120,000 doctors by 2030.
Nurse practitioners, however, can provide the bulk of the preventive and routine care that’s offered by primary care providers, either on their own or working with physicians, according to the report. The researchers found that NPs provide quality care on par with that of doctors, and that they did so at a lower cost—on average, between 11% and 29% less than care provided by physicians.
In addition, despite the decline in primary care physicians, the number of nurse practitioners is on the rise. In 2018, about 248,000 NPs will provide about 1 billion care visits.
“There is an alignment of the public policy and of the private policy around this idea,” said Peter Buerhaus, Ph.D., the report’s author and a nurse and healthcare economist at Montana State University.
However, many NPs and other advanced practice clinicians are unable to practice at the top of their license in more than half of states. Just 23 states and the District of Columbia allow nurse practitioners full practice authority, according to the report.
Sixteen states have reduced practice regulations, which means at least one element of their practice is limited and they’re often required to work in a collaborative agreement with a physician or other clinician. The remaining 12 states have restricted practice protocols, according to the report, which may require career-long supervision by physicians to practice. In states with scope-of-practice restrictions, up to 40% fewer primary care nurse practitioners were available to address access gaps, according to the report.
“Physicians groups often feel it's is a loss to them, so it’s pitched as a win-lose argument in many ways," Buerhaus said. But in reality, NPs often fill gaps where primary care physicians aren't available.
After diving into this data, Buerhaus offered three policy recommendations that can open the door for nurse practitioners to ease the primary care shortage. Each targets a different stakeholder that can play a role:
- Private policymakers, such as hospital boards: Convene discussions between nurse practitioners, physicians and state and local leaders to drive these changes. Hospital boards and licensing bodies should allow NPs to practice at their full scope, according to the report.
- Physicians: Doctors must be willing to accept the role that NPs and other advanced practice clinicians can play in providing quality care. Different types of clinicians can work together to address gaps and improve rural healthcare, according to the report.
- Public policymakers: These stakeholders, according to the report, should prioritize ending scope of practice restrictions.