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A 2018 study by the American Enterprise Institute (AEI) called “Nurse Practitioners: A Solution to America’s Primary Care Crisis,” by Peter Buerhaus, suggested that NPs can help with the problems of not having enough primary care physicians in particular areas of the United States.
David Hebert, JD, Chief Executive Officer of the American Association of Nurse Practitioners (AANP), recently explained how NPs can make a difference and what can stand in their way.
What follows is an edited version of the interview.
How many states restrict NPs scope-of-practice? What are the limits—what are they not allowed to do in these states that other states allow them to do? If they are allowed their total scope-of-practice, are they able to do everything that a primary care doctor can do?
Currently, 28 states don’t allow NPs to practice to the fullest extent of their training and licensure. Twelve of these—including California, Texas, and Florida—are “restricted practice” states, where the law restricts NPs ability to provide care without a formal contract with a physician. Sixteen other states, including Pennsylvania, Ohio, and Kentucky, are “reduced practice” states, where state regulations limit NPs’ ability to treat patients in certain care settings.
In 22 states, the District of Columbia, and Guam, NPs have full practice authority. This means NPs evaluate patients, diagnose, order and interpret diagnostic tests, as well as initiate and manage treatments under the exclusive licensure authority of the state board of nursing.
NPs and physicians both have the skill set to provide the full range of primary care services to patients. It’s not really about the provider—it’s about giving patients a choice of provider and ensuring them access to high-quality health care. NPs are a critical component of care teams. We work with all kinds of providers in every care setting to make sure patients get the best possible care. When it comes to scope-of-practice laws, we want NPs to be allowed to practice to the fullest extent of their training and licensure.
With the lack of primary care physicians, especially in rural and medically underserved areas, what can the NP bring to the community?
NPs ensure patients in rural communities have greater health care access, especially in primary care. The AEI report confirmed that while the NP workforce is growing significantly, the physician workforce is growing at a much slower rate. The study also concluded what we’ve seen in our own work: primary care NPs (PCNPs) are more likely to practice in rural areas, where the need for primary care is greatest.
It’s important to remember that primary care can prevent additional health complications for patients, making NPs a vital resource for rural communities. People living in states with laws that reduce or restrict NPs’ scope-of-practice have significantly less access to PCNPs. This finding indicates that such state regulations have played a role in impeding access to primary care. This alone should be cause for concern among policymakers seeking to improve public health.
When NPs have moved into areas and had the complete ability to practice, what have been some of the results?
In U.S. News & World Report’s 2018 Best State Rankings, nine of the top ten states for best health care allow patients full and direct access to NP care. According to Buerhaus, author of AEI’s report, people living in states that do not restrict NP scope-of-practice have significantly greater geographic access to primary care. More and more people are choosing NPs because the quality is high and accessible as well as because NPs take into account the needs of the whole patient, which resonates with today’s families.
What would you say to patients who might be afraid that they are getting lesser care in being treated by an NP as opposed to a doctor? How can NPs and other health care providers help patients to understand the benefits?
It’s important for patients to feel comfortable in their selection of a health care provider. Research shows that NPs achieve health outcomes for their patients equal to—and in some cases—greater than their physician counterparts. We encourage patients to consider an NP, take time to learn more about the care NPs provide at www.WeChooseNPs.org, and if it’s the right choice for them, to visit NPfinder.org, where they can find an NP in their area.
We’ve launched a nationwide campaign called We Choose NPs that showcase patients who choose NPs as their primary care providers. We believe it’s important for patients to have access to high-quality primary care and to have the information available to make the right health care choice for their family.
NPs are strengthening health care in a variety of important ways. Recently, Congress passed comprehensive opioid legislation that makes permanent the temporary authorization granted nurse practitioners (NPs) and PAs to provide lifesaving medication assisted treatments (MATs) for patients battling addiction. After conducting a billion patient visits last year alone, we’re very excited about the future and the opportunity to help patients nationwide.