Nurse Practitioners to the Primary Care Shortage Rescue?

As the U.S. population grows and health insurance coverage expands, the demand for primary care is steadily increasing, giving rise to a shortage in primary care physicians (PCPs). In answer to this shortage, Kaiser Family Foundation (KFF) suggests filling the gap with increased use of nurse practitioners (NPs).

ACA Provisions

The Patient Protection and Affordable Care Act (P.L.111-148) (ACA) contributes to health coverage growth across the country and provides incentives to PCPs to address Health Professional Shortage Areas (HPSAs). Not only does the ACA offer a 10 percent Medicare payment bonus for five years to physicians and general surgeons practicing in HPSAs, the ACA also allows the HHS Secretary to award three-year grants to eligible entities to operate NP programs as part of a training demonstration program. Grant awardees will enroll and employ graduates of NP programs and provide one-year training for careers as PCPs in HPSAs. In 2012, HHS awarded $15 million in such grants to support 10 clinics.

Shortage

KFF notes that at least 58 million Americans reside in geographic areas or belong to population groups that are considered HPSAs, in which the supply of PCPs relative to the population falls below federally defined standards. The proportion of Americans living in HPSAs varies from state-to-state, with a little over 1 percent in Nebraska to 57 percent in Mississippi. In 19 states, the proportion is at least 20 percent and in six states, it exceeds 30 percent (Alabama, Arizona, the District of Columbia, Louisiana, Mississippi, and New Mexico). It is estimated that by 2020, there will be a shortage of 20,400 PCPs.

Power of NPs

NPs are registered nurses who have completed Master’s degrees or higher-level nursing degrees. Nearly 90 percent of all NPs are trained in primary care and able to prescribe medications. NPs are more likely to practice in urban and rural areas and serve a high proportion of uninsured patients and other vulnerable populations. Research shows that NPs can manage 80 to 90 percent of the same care provided by PCPs, although NPs achieve training in fewer years than PCPs (an average of six years of education and training versus 11 or 12 years, respectively).

Barriers

Unfortunately, there are some barriers to the extended use of NPs. Some states require NPs to have a regulated collaborative agreement with a PCP in order to provide patient care and limit NPs’ engagement in at least one element of NP practice, according to KFF. Only 20 states allow NPs to have full-practice authority.

In its 2011 report, “The Future of Nursing: Leading Change, Advancing Health,” the Institute of Medicine (IOM) specifically noted, “Remove scope-of-practice barriers” as one of its first recommendations to solve the PCP shortage. The IOM report called for a Federal Trade Commission (FTC) review of state regulations and for the Department of Justice (DOJ) to identify states with unjustified anticompetitive effects.

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