Opinion
Can nurse practitioners solve the primary care shortage?
An estimated 100 million people in the United States—almost a third of the population—don’t have a primary care provider. Nurse practitioners could bridge this urgent health care gap, but social stereotypes that portray nurses as subordinate to doctors, along with archaic state regulations, prevent these qualified professionals from doing so.
The current care gap is driven mostly by a lack of doctors. Medical students are choosing higher-paying specialties over practicing primary care. Often, this is to help them pay their medical school debt.
The nursing community is poised to fill that gap. There are 5.2 million registered nurses in the U.S., and they are increasingly earning degrees and certifications that qualify them as primary care providers. More than 70 percent of RNs hold a bachelor of science degree, a number that is growing. Then there are 385,000 licensed nurse practitioners—a designation that allows them to order tests, diagnose patients, and prescribe treatments, just as a doctor would. Nearly 90 percent of nurse practitioners working in the U.S. today have a master’s or doctorate degree and are fully certified to practice in areas such as pediatrics, family medicine, women’s health, adult medicine, or gerontology.
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It usually takes at least seven years and an average of 7,840 hours of clinical training and work experience to become a nurse practitioner. Nurse practitioners are well-trained for primary care work—and evidence shows they deliver it effectively, and often at a lower cost than doctors. Studies show that patients of nurse practitioners received the same quality care from nurse practitioners as from doctors, and that they feel highly satisfied with their care.
Other research shows that being seen by a nurse practitioner incurs costs similar to or less than being treated by a physician. One study, which analyzed two years of data from more than 47,000 medically complex patients with diabetes at 566 Veterans Administration facilities, found savings of at least hundreds of dollars per patient: $1,300 for hospitalization or emergency visits, $500 for outpatient care, and $300 in pharmacy costs. Another study, which analyzed four years of data from 475,000 Medicare beneficiaries, found that the patients of nurse practitioners received high-quality care while costing less for office visits as well as emergency room visits, hospital stays, nursing homes, and specialty care.
In 27 states, the District of Columbia, and U.S. territories, nurse practitioners are fully authorized to practice as independent clinicians. They conduct physical exams, make diagnoses, order and interpret lab tests and imaging studies, prescribe medications, provide treatment, and perform procedures, just like primary care physicians do. But when people think about their primary care, they think of the word “doctor.”
If policymakers and other industry decision-makers can help patients in the U.S. see nurse practitioners as primary care providers, patient access and health outcomes would improve, and health care costs would go down. Updating the laws and regulations in the states that don’t yet authorize nurse practitioners to work this way would help. But real change needs public health and health care practitioners to collaborate to change people’s minds. Patients and the public need to learn they can turn to nurse practitioners for expert, quality care.
To be sure, nurse practitioners are not physicians. But access to primary care nurse practitioners trumps no access every time. There is plenty of need—and space within health care—for physicians and nurse practitioners to work independently and collaboratively for the good of all the people in the United States who need care.
Source images: CreativeArchetype / iStock, SDI Productions / iStock, s-cphoto / iStock
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<p>Without enough doctors, the U.S. needs other avenues of access.</p>
<p>Written by Grace Han</p>
<p>This <a rel="canonical" href="https://harvardpublichealth.org/policy-practice/can-a-nurse-practitioner-be-a-pcp-an-experienced-np-explains/">article</a> originally appeared in<a href="https://harvardpublichealth.org/">Harvard Public Health magazine</a>. Subscribe to their <a href="https://harvardpublichealth.org/subscribe/">newsletter</a>.</p>
<p class="has-drop-cap">An estimated <a href="https://www.usatoday.com/story/news/health/2023/02/28/americans-lack-primary-care-provider-report/11359096002/" target="_blank" rel="noreferrer noopener">100 million</a> people in the United States—almost a third of the population—don’t have a primary care provider. Nurse practitioners could bridge this urgent health care gap, but social stereotypes that portray nurses as subordinate to doctors, along with archaic state regulations, prevent these qualified professionals from doing so.</p>
<p>The current care gap is driven mostly by a lack of doctors. Medical students are choosing <a href="https://www.cbsnews.com/news/primary-care-doctors-shortage-pay-procedures/" target="_blank" rel="noreferrer noopener">higher-paying specialties</a> over practicing primary care. Often, this is to help them pay their medical school debt.</p>
<p>The nursing community is poised to fill that gap. There are <a href="https://www.journalofnursingregulation.com/article/S2155-8256(23)00047-9/fulltext" target="_blank" rel="noreferrer noopener">5.2 million registered nurses in the U.S.</a>, and they are increasingly earning degrees and certifications that qualify them as primary care providers. More than 70 percent of RNs hold a bachelor of science degree, a number that is growing. Then there are 385,000 licensed nurse practitioners—a designation that allows them to order tests, diagnose patients, and prescribe treatments, just as a doctor would. <a href="https://www.aanp.org/about/all-about-nps/np-fact-sheet" target="_blank" rel="noreferrer noopener">Nearly 90 percent</a> of nurse practitioners working in the U.S. today have a master’s or doctorate degree and are <a href="https://nurse.org/resources/nurse-practitioner/" target="_blank" rel="noreferrer noopener">fully certified</a> to practice in areas such as pediatrics, family medicine, women’s health, adult medicine, or gerontology.</p>
<p>It usually takes at least seven years and an average of 7,840 hours of clinical training and work experience to become a nurse practitioner. Nurse practitioners are well-trained for primary care work—and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7080399/" target="_blank" rel="noreferrer noopener">evidence</a> shows they deliver it effectively, and often at a lower cost than doctors. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7080399/" target="_blank" rel="noreferrer noopener">Studies</a> show that patients of nurse practitioners received the same quality care from nurse practitioners as from doctors, and that they feel highly <a href="https://www.aanp.org/advocacy/advocacy-resource/position-statements/quality-of-nurse-practitioner-practice" target="_blank" rel="noreferrer noopener">satisfied</a> with their care.</p>
<p><a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2019.00014" target="_blank" rel="noreferrer noopener">Other research</a> shows that being seen by a nurse practitioner incurs costs similar to or less than being treated by a physician. One <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2019.00014" target="_blank" rel="noreferrer noopener">study</a>, which analyzed two years of data from more than 47,000 medically complex patients with diabetes at 566 Veterans Administration facilities, found savings of at least hundreds of dollars per patient: $1,300 for hospitalization or emergency visits, $500 for outpatient care, and $300 in pharmacy costs. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6338303/" target="_blank" rel="noreferrer noopener">Another study</a>, which analyzed four years of data from 475,000 Medicare beneficiaries, found that the patients of nurse practitioners received high-quality care while costing less for office visits as well as emergency room visits, hospital stays, nursing homes, and specialty care.</p>
<p>In <a href="https://nursejournal.org/nurse-practitioner/np-practice-authority-by-state/" target="_blank" rel="noreferrer noopener">27 states</a>, the District of Columbia, and U.S. territories, nurse practitioners are fully authorized to practice as independent clinicians. They conduct physical exams, make diagnoses, order and interpret lab tests and imaging studies, prescribe medications, provide treatment, and perform procedures, just like primary care physicians do. But when people think about their primary care, they think of the word “doctor.”</p>
<p>If policymakers and other industry decision-makers can help patients in the U.S. see nurse practitioners as primary care providers, patient access and health outcomes would improve, and health care costs would go down. Updating the laws and regulations in the states that don’t yet authorize nurse practitioners to work this way would help. But real change needs public health and health care practitioners to collaborate to change people’s minds. Patients and the public need to learn they can turn to nurse practitioners for expert, quality care.</p>
<p class=" t-has-endmark t-has-endmark">To be sure, nurse practitioners are not physicians. But access to primary care nurse practitioners trumps no access every time. There is plenty of need—and space within health care—for physicians and nurse practitioners to work independently and collaboratively for the good of all the people in the United States who need care.</p>
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