Rural And Nonrural Primary Care Physician Practices Increasingly Rely On Nurse Practitioners

Hilary Barnes; Michael R Richards; Matthew D McHugh; Grant Martsolf

doi:10.1377/hlthaff.2017.1158

Rural And Nonrural Primary Care Physician Practices Increasingly Rely On Nurse Practitioners

Health Aff (Millwood). 2018 Jun;37(6):908-914. doi: 10.1377/hlthaff.2017.1158.

Authors

Hilary Barnes¹, Michael R Richards², Matthew D McHugh³, Grant Martsolf⁴

Affiliations

¹ Hilary Barnes ( hbarnes@udel.edu ) is an assistant professor in the School of Nursing, University of Delaware, in Newark.
² Michael R. Richards is an assistant professor of health policy at Vanderbilt University, in Nashville, Tennessee.
³ Matthew D. McHugh is a professor of nursing; the Independence Chair for Nursing Education, Center for Health Outcomes and Policy Research; and a senior fellow at the Leonard Davis Institute of Health Economics, all at the University of Pennsylvania, in Philadelphia.
⁴ Grant Martsolf is a professor in the Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, and an adjunct policy researcher at the RAND Corporation in Pittsburgh, both in Pennsylvania.

Abstract

The use of nurse practitioners (NPs) in primary care is one way to address growing patient demand and improve care delivery. However, little is known about trends in NP presence in primary care practices, or about how state policies such as scope-of-practice laws and expansion of eligibility for Medicaid may encourage or inhibit the use of NPs. We found increasing NP presence in both rural and nonrural primary care practices in the period 2008-16. At the end of the period, NPs constituted 25.2 percent of providers in rural and 23.0 percent in nonrural practices, compared to 17.6 percent and 15.9 percent, respectively, in 2008. States with full scope-of-practice laws had the highest NP presence, but the fastest growth occurred in states with reduced and restricted scopes of practice. State Medicaid expansion status was not associated with greater NP presence. Overall, primary care practices are embracing interdisciplinary provider configurations, and including NPs as providers can strengthen health care delivery.

Keywords: Nurse Practitioners; Primary Care; Rural Health Care; Team-based Care; Workforce Issues.

Publication types

Comparative Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
Female
Health Care Surveys
Humans
Male
Nurse Practitioners / legislation & jurisprudence
Nurse Practitioners / supply & distribution*
Nurse's Role
Outcome Assessment, Health Care
Physicians, Primary Care / organization & administration
Practice Patterns, Physicians' / organization & administration*
Primary Health Care / organization & administration*
Quality of Health Care*
Rural Health Services / organization & administration*
Rural Population
United States
Urban Population

Grants and funding

T32 NR007104/NR/NINR NIH HHS/United States