The impact of nurse practitioner scope of practice regulations in primary care

Background

The benefits of an adequate supply of primary care providers on patient health have been well documented in the scientific literature, including improved care coordination and better overall patient outcomes (Macinko et al, 2007, Starfield et al, 2005). However, a shortage of primary care physicians (MDs) in the United States is estimated to exceed 52,000 by 2025 (Petterson et al., 2012), most notably in key geographic locations, including medically underserved and health professional shortage

Discussion

Overall, our study showed a 19.2% decreased odds of a patient having a 30-min or more drive to NPs or MDs in a state where NPs can practice independently, compared with states with a more restrictive NP regulation. States with independent NP regulatory practices are, in general, large, rural states, with wide population distributions by the U.S. Census Block Group: Montana, Wyoming, and Idaho are examples. In contrast, states with the most restrictive NP practice regulatory environments (AANP,

Limitations

The current study has specific limitations that must be considered. First, because national data that represent the populations' travel behavior or travel mode choice was not available, travel time was estimated by the assumption that all populations reached their primary care provider by personal vehicles. To compensate for this limitation, the present study used detailed hierarchical road network data, with speed limit classification, although the lack of understanding of the populations'

Conclusion

To our knowledge, this was the first study assessing the association of NP regulations by state and patient access to care by drive time to primary care providers. Point estimates suggest that states with full NP scope of practice have a lower percentage of the population with a greater than 30-min drive time to receive care compared with states that restrict NP practice. NPs practicing in states that require MD supervision are reliant on these practices, limiting their geographic distribution.

Funding

This work was supported by Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative.

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  Studies indicate the general NP workforce expands in states that grant NPs independent practice authority (Xue, Ye, Brewer, & Spetz, 2016; Hooker & Muchow, 2015). Because NPs are more likely than physicians to practice in rural areas, a study by Neff et al. (2018) demonstrated there was greater access to primary care in states with autonomous NP practice after assessing the distance patients had to drive to receive care. Another study of utilization and NP practice authority found NPs in states with full practice authority provided more mental health services than physicians in community health centers when compared with states without autonomous practice (Yang et al., 2017).

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