Health Policy$ense

Chart of the Day: Nurse Practitioners in Primary Care

Physician practices increasingly rely on nurse practitioners

A new study in Health Affairs by Hilary Barnes, Matthew McHugh, and colleagues, demonstrates the increasingly important role nurse practitioners (NPs) have in primary care in the United States.

Using national physician practice-level data from 2008-2016, the authors found that more practices are employing NPs, and there are more NPs in each practice. In 2016, 43.4 percent of rural practices employed at least one NP, up from 31.4 percent in 2008. Nonrural practices saw a similar trend: in 2016, 26.5 percent of nonrural practices employed at least one NP, up from 18.3 percent in 2008. The average number of NPs per practice also increased significantly in rural (1.34 to 1.64) and nonrural practices (1.47 to 1.67).


Percentages of primary care practices with nurse practitioners (NPs) and average number of NPs in primary care practices in rural and nonrural areas, 2008–16. Source: Health Affairs

The authors also looked for differences in NP presence by varying state scope of practice laws and Medicaid expansion status. Scope of practice is regulated by states, and determines an NP’s ability to practice and prescribe medications with or without physician supervision or collaboration. States that grant nurses full scope of practice had the highest NP presence, but the fastest growth of NPs occurred in states with reduced and restricted scopes of practice. Expanded Medicaid eligibility was not associated with greater NP presence.

Nurse practitioners can deliver most of the care primary care physicians provide, and this care is safe and of high quality. It makes sense, then, that physician practices are embracing diverse provider configurations. The authors conclude, “Adding NPs is a useful way for practices to align themselves with contemporary efforts to improve access and performance.”

For more on methods and policy implications, read the full study.