Nurse Practitioners Can Cure America's Primary Care Shortage

Nurse Practitioners Can Cure America's Primary Care Shortage
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During the first week of October, America celebrates National Primary Care Week, honoring the difficult work that family physicians, pediatricians, and other primary care doctors do every day to provide routine medical care. But, unfortunately for us, there aren’t enough of them to care for our country’s growing medical needs. Over 84 million Americans, one quarter of the U.S population, live in counties with a severe primary care physician shortage, according to data from the Department of Health and Human Services (HHS). From Colusa County in California to East Delaware County in New York, patients are suffering from this debilitating doctor shortage – and it’s expected to worsen with an aging population.

This year, in addition to recognizing the achievements of primary care physicians, lawmakers should enact reforms that will help expand the number of primary care providers available, thereby lowering costs and improving access for tens of millions of families across the country.

At the same time that America’s aging Baby Boomer generation is entering retirement and demanding more health care services, many doctors are also retiring and hanging up their lab coats. Researchers at the Association of American Medical Colleges estimate that by 2030, there will be 49,000 fewer primary care physicians than we will need to serve our growing health care needs. This means patients will have to travel farther, wait longer and pay more for basic primary care services.

One simple and effective solution to this widening primary care shortage is to allow qualified professionals known as nurse practitioners (NPs) to deliver more health care services. NPs are registered nurses educated at the master’s or post master’s level. They are trained to provide all sorts of primary care services, including diagnosing and treating many common illnesses and prescribing medications.

However, despite their extensive qualifications, many states have put into place numerous barriers to limit the services NPs can provide. In 28 states—including California, Florida and Texas—lawmakers subject nurse practitioners to outdated regulations that prohibit them from providing treatments they are fully certified to offer. In other instances, states mandate nurses practice under the direct supervision of a physician, which limits their capacity to serve remote communities.

Supporters of these restrictions claim that allowing nurses to perform primary care services would endanger patients’ health. However, nurses can perform nearly all the services of a primary care doctor at the same high standards we expect from physicians. A 2013 review of 26 peer-reviewed studies in the journal Health Affairs found that patients treated by NPs enjoy the same health outcomes as those served by physicians.

Relaxing state restrictions on NPs would dramatically expand access to high-quality primary care. Since NPs require fewer years of training to practice than physicians, they can readily deploy to underserved areas with the greatest health care needs. Surveys conducted by the American Academy of Nursing have found that nurses are far more likely than doctors to operate in rural communities and in nontraditional settings like urgent care and in-store clinics, which allow them to reach patients who lack reliable access to physicians.

Another benefit NPs offer to patients is that they charge significantly less than doctors. Because the cost of a nursing degree is much lower than what physicians must spend to obtain a medical degree and license, NPs are able to pass along those savings to patients in the form of lower prices. According to research by economist Morris Kleiner of the Brookings Institution, preventive care for children costs 16 percent less in states that allow nurses to freely practice medicine. This means that not only do NPs expand access to primary care, but they also lower costs for these important services.

Because of NPs’ enormous and well-documented capacity to provide affordable primary care, the federal government has repeatedly recommended states remove burdensome restrictions on NPs. In 2013, the Department of Health and Human Services (HHS) estimated states could reduce America’s primary care shortage by two-thirds simply by loosening laws that prevent nurses from independently treating patients. And earlier in 2018, HHS Secretary Alex Azar urged lawmakers attending the American Legislative Exchange Council’s conference in New Orleans to end their “barrier[s] to new competition and lower-cost [nurse practitioners].”

Medical experts and policymakers across the political spectrum recognize that NPs can make a big difference in the lives of millions of Americans who are struggling to attain primary care. Allowing these qualified nurses to independently serve patients is a bipartisan solution that states should adopt—finally granting enough medical care access to those who need it most.

Charlie Katebi ( is a state government relations manager at The Heartland Institute, as well as a healthcare and welfare policy fellow at the Millennial Policy Center. Both are national nonprofit, nonpartisan, public policy think tanks.

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