Growing number of primary care practices employ nurse practitioners

Doctors talking
Both rural and nonrural practices are employing more nurse practitioners. (Getty/wmiami)

Nurse practitioners are a growing part of primary care teams, according to a recent Health Affairs study.

But they are especially filling a gap in rural areas, where primary care doctors are in short supply. The share of rural practices employing nurse practitioners increased from 31.4% in 2008 to 43.4% in 2016, the study found. In nonrural practices, there was a less-dramatic increase of 8.2 percentage points.

In 2016, nurse practitioners made up 25% of providers in rural practices and 23% in nonrural practices. That was an increase from 2008, where nurse practitioners accounted for 18% of providers in rural practices and 16% in nonrural practices.


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The study, which looked at physician practice data between 2008-2016, also found that states with full scopes of practice for nurse practitioners had the highest percentages of practices that employ NPs. The study defined a full scope of practice as when nurse practitioners can practice without a collaborative agreement with a physician.

And while it seems counterintuitive, the fastest growth came in states with reduced and restricted scopes of practice. With a restricted scope of practice, an NP is required to maintain a collaborative agreement with a physician for practicing and prescribing. With a reduced scope of practice, the NP needs a collaborative agreement for prescribing authority only.

Just how much authority nurse practitioners should have to practice on their own is a controversial question resulting in “long-standing turf wars.”

For instance, the American Medical Association last year adopted a resolution that calls for a national strategy to oppose legislative efforts that grant independent practice to nonphysician practitioners. That led the American Nurses Association and the American Association of Nurse Practitioners to fire back that such an effort will protect physicians and not patients.

Despite the controversy, primary care practices are supplementing their workforce with NPs.

"Our findings imply that primary care practices are embracing a more diverse provider configuration, which may strengthen healthcare delivery overall," the authors concluded.

One study said nurse practitioners could offer relief for primary care offices struggling with the physician shortage and rising burnout rates. The country could see a shortage of up to 120,000 physicians by 2030, according to the latest statistics from the Association of American Medical Colleges.

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