October 03 2019

How Nurse Practitioners Can Help Reduce the Physician Shortage

How Nurse Practitioners Can Help Reduce the Physician Shortage

The growing physician shortage is causing an ever-increasing demand for health care professionals. One way to meet the growing demand for qualified health care providers is to allow Nurse Practitioners (NPs) full practice authority. While this would provide easier access for patients and keep costs down, the decision to give full practice authority to NPs is divided.

In 2010 the Institute of Medicine issued a report with eight recommendations to improve healthcare in the United States. One of the recommendations was to increase access to care by allowing NPs to practice to the full extent of their education and training, including diagnosing patients, prescribing medications, and making referrals (1). In 2017 over 20 states passed laws to lift some or all restrictions on NPs. In 2018 a report by the Department of Health and Human Services, the Departments of Treasury and Labor, and the Federal Trade Commission recommended that states change their scope of practice statutes to let healthcare providers use their full skillsets to provide care to patients (2). The report also urged states to eliminate rigid supervisory agreements between physicians and NPs that are not justified by legitimate health and safety concerns.

Texas is an example of a state that restricts how an NP can practice and requires physician supervision, but recently eliminated the requirement of the physician being onsite. When NPs write prescriptions, they must include the supervising physician’s name, address, DEA number, and phone number (3). Texas physicians can only supervise up to four NPs at one time, and physicians must randomly review at least 10% of the NP's patient charts each month. With Texas currently ranking 42nd nationwide in its ratio of doctors per 100,000 people, increasing access to healthcare should be a priority.

New Mexico is an example of a state where NPs are given full independent practice authority. This is essential, especially in the state's large rural areas where a nurse practitioner may be the only health care contact in that community. This independence also allows NPs to play a crucial role in combatting the opioid epidemic by prescribing treatment medications (4).

Both NPs and physicians agree that it is valuable for NPs to have some association with physicians. But some physician groups do not support giving NPs full practice authority. The hesitation does not come from a fear of competition. Their main concern is patient care, specifically when complications occur while patients are under an independent NP’s care (5). A physician's extended education and more extensive training experience better prepares them for when complications arise.

The concern for patient complications is somewhat mitigated by the scope of practice for NPs in a primary care setting. There is no evidence that patients in states with a more restrictive scope of practice for NPs have better health outcomes than in states with less restrictive laws. Also, costs are lower in states that allow NPs to do more. According to a Forbes article titled "It's Time To Expand Scope Of Practice Laws," eliminating restrictions on NPs will result in annual savings of $543 million nationwide.

Bipartisan support in state legislatures to update these laws is growing. There are three things that state legislatures can do to help make the transition to full practice authority agreeable to both sides. First, they can authorize full scope of practice to NPs, giving them more independence to better serve patients. Second, legislators can allow physicians and NPs to determine their relationship at the practice level instead of the state level. This will eliminate one-size-fits-all state requirements. Third, state legislators and licensing authorities can consult with the Federal Trade Commission to ensure they are not restricting competition and that they are not harming patients (6).

Taking these steps may enable NPs and physicians to work together more effectively. After all, both are striving to improve population health, reduce health care cost, to satisfy healthcare providers, and to satisfy patients. 



  1. Nurse practitioners gain ground on full practice authority, Nurse.com
  2. Reforming America’s Healthcare System Through Choice and Competition, U.S. Department of Health and Human Services, U.S. Department of the Treasury, U.S. Department of Labor
  3. How Does Nurse Practitioner Authority Vary By State?, Nurse Practitioner Schools website
  4. Expanding the Role of Nurse Practitioners, CHCF
  5. More States Pushing For Autonomy In Scope-Of-Practice Battle, HealthLeaders
  6. It's Time To Expand Scope Of Practice Laws, Forbes

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