Advanced Practice Nurses Critical to Increasing Access to Primary Care

There are more than 355,000 nurse practitioners (NPs) licensed in the US. NPs are nurses with masters or doctoral degrees and advanced training who can assess and diagnose patients, order and interpret diagnostic tests, and prescribe medicine with or without physician supervision. And they make up 43% of primary care providers in the US!

In 27 states and Washington, D.C., NPs can practice without physician supervision. In 12 states NPs can diagnose and treat patients independently but require physician supervision to prescribe. Supervision does not require that physicians be present in the practice; the providers sign a paid collaborative agreement and physicians may review charts and advise NPs via scheduled in-person and online meetings, and/or via telephone and email.

In “full practice” and “restricted practice” states, NPs can—and do—own and lead their own primary care practices or practice in schools, skilled nursing facilities, worksite and mobile clinics, in homes, and other settings. According to the American Association of Nurse Practitioners (AANP), 88% of licensed NPs in the US (70% in clinical practice) are certified and prepared in primary care with a focus on family, pediatrics, women’s health, geriatrics, neonatal, or psychiatric mental health.

In all 50 states and the District of Columbia, whether supervised or not, NPs hold prescriptive authority and complete more than 1 billion patient visits annually. And, they make up 25% of rural providers. 

This critically important healthcare workforce is professionally and personally committed, entrepreneurial, and collaborative. They partner with physicians even where the law does not require supervision. They are increasingly completing degree and training programs that prepare them for solo practice, and they refer patients to specialists when indicated, just as primary care physicians do. 

However, while the AANP and other nurse organizations, the Institute of Medicine (IOM), the National Governors Association (NGA), the Federal Trade Commission (FTC), the Bipartisan Policy Center, and the Veteran’s Health Administration (VHA) all support full practice for NPs, the American Medical Association (AMA) and many physician organizations do not. They respect, value, and rely upon NPs as part of physician-led care teams but worry that NPs lack sufficient training to practice alone and therefore may overprescribe or over-utilize resources. They also express concern that, because NPs do not complete multi-year residencies and complete only 500-720 hours of clinical training (physicians complete 10,000-16,000), patients’ safety and health outcomes may be threatened.

So, now what? 

In a perfect world, we would easily meet or beat a 2000-to-1 patient to primary care physician ratio (the bar for determining whether there is a provider shortage, factoring in health equity). But it’s not a perfect world. So, we seek mental health care via mobile apps because there are not enough providers in our insurers’ networks. We wait for health fairs to get free health screenings years too late. We click/dial an anonymous doctor to get a prescription. We have health crisis-level, maternal-child mortality rates because we can’t let go of racism and just listen. We allow kids to suffer when pediatric healthcare services are severely restricted and don't create quality incentives for children's care because it's not profitable. We go bankrupt trying to pay for life-saving care.

So, in this wonderfully imperfect world, we must look to the primary care providers that patients/consumers trust most to help us extend our collective primary health care resources—with AND without physician supervision.

79% of U.S. adults say nurses have “very high” or “high” honesty and ethical standards, far more than any of the other 17 professions rated. -Gallup 2022 survey

We are already struggling with the effects of the growing primary care provider shortage (up to 180,000 by 2034, according to AAMC: 

• Fifty-eight million (58M) Americans live in an area or belong to a population that is considered a primary care shortage area. 
• Eighty percent (80%) of rural communities are shortage areas. 
• Burnout among healthcare providers (53% of physicians and 60% of NPs) is creating record pre-retirement exits.
• Health equity does not yet exist.

Active support of full and restricted practice NPs--and other advanced and alternative practice healthcare professionals is part of a multi-front solution to the health care crisis in America. Other solutions like (1) funding and creating more primary care residencies, especially in rural and low-income areas, (2) having state- and municipality- employed physicians supervise NPs to standardize supervision and fees, and (3) affordably, priced direct health care provided by primary care physicians and specialists (and even facilities) are also part of a long-term solution.

We at the Wonder Guild are enthusiastic supporters of safely, appropriately increasing practice authority so that highly skilled, committed, and compassionate nurse practitioners, physicians assistants, and other advanced and alternative practice providers can provide affordable, high-quality care wherever it is needed.

If you are an Nurse Practitioner or other advanced practice professional who is starting or growing your own practice, message me or join The Wonder Guild's beta where we are launching a new way to help direct health care providers grow their practices by introducing them to thousands of individuals and families and employers near their practices.

Learn more about advanced practice/full practice authority for NPs with peer-reviewed research

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