Response: Full practice authority for nurse practitioners needed to address physician shortage

We are facing a primary care crisis in this country that existed before COVID-19, but which has most certainly been exacerbated by it.

I read with interest Medical Economics’ interview with Alyson Maloy, MD, of Physicians for Patient Protection (PPP). It is unfortunate that to address the importance of solving our nation’s primary care provider shortage, reducing burnout and ensuring care for rural patients amid the COVID-19 pandemic, the author opted to interview a representative of an advocacy group that exists on the far fringes of organized medicine. Maloy and PPP would have physicians and medical students believe their profession — and indeed patients — are somehow undermined by the outstanding care nurse practitioners (NPs) deliver.

Every day, NPs work alongside physicians who support full and direct access to NP-delivered care. Unfortunately, PPP is an outlier organization, working to divide NPs and physicians rather than unite us to better serve patients and our nation’s health care system. We as NPs want our physician colleagues to know the facts.

We are facing a primary care crisis in this country that existed before COVID-19, but which has most certainly been exacerbated by it. The pandemic has shone a bright light on the impact poor health care access has on underserved communities — and all communities. Today, some 83 million Americans lack adequate access to primary care, with only about 44% of the nation's primary care health needs being met. This demand for care far outstrips the supply of physicians. While it is well known that the primary care physician workforce is shrinking, by 2030, estimates show that the nation will face shortages of more than 139,000 health care providers.

Full practice authority (FPA) strengthens patients’ access to high-quality care.

The physician workforce is increasingly gravitating toward medical specialties and resides most frequently in urban centers. In contrast, nearly 90% of NPs are prepared in primary care, and data shows they are more likely to practice in rural areas than are physicians. After adopting FPA, states like Arizona, Nevada and North Dakota saw a significant increase in the number of NPs licensed in the state and better retention rates for NP graduates who remained in the state after graduation. In fact, Arizona saw an increase of more than 70% of rural-located NPs within five years of adopting FPA.

Fifty years of research confirms the high quality of NP-delivered health care.

The evidence is in, NP-delivered care is associated with improved access to care, lower health care costs and fewer avoidable emergency room visits and hospital readmissions compared to other health professions. A preponderance of evidence based on more than half a century of research definitively demonstrates that NPs provide high-quality primary, acute and specialty health care services across the life span and in diverse settings, including NP-owned practices. NP outcomes are comparable to that of physicians, and research from the New England Journal of Medicine and the Journal of the American Medical Association supports this. Moreover, The Federal Trade Commission and National Governors Association both recommend that states lift NP practice barriers as strategies to improve access and address health care costs.

Rural communities need help – and NPs are prepared to deliver it.

Patients living in rural communities are five times more likely to live in a primary care provider shortage area than those in urban or suburban areas. In fact, while physicians are likely to be concentrated in urban areas, NPs are more likely to settle in rural areas. NPs represent one in four providers in rural practices and represent a higher percentage of providers in states with FPA laws. Even more telling, modernizing scope of practice regulations would reduce the number of rural patients designated as living in primary care shortage areas from 23 million to 8 million people,due to the estimated increase in NPs working in these communities.

Trusted health policy advisors agree: It’s time to enact FPA nationwide.
While PPP’s representatives work overtime to fight FPA, the National Academy of Medicine (NAM) — the nation’s most respected medical policy research organization and adviser to the U.S. government — recently issued a renewed call for policymakers to empower NPs to work to the top of their scope. In the words of William M. Sage, MD, JD, who served on the authoring committee of the NAM’s report, The Future of Nursing 2020-2030: Charting a Path to Health Equity, “Fulfilling the promise of nursing means speaking truth to the medical establishment and making it acknowledge an ethical obligation to reform professional hierarchies. The laws and norms that constrain nurses’ ability to practice to the full extent of their skills and training were put Bottom of Formin place by physicians to protect their privileges, independence, and income. As the COVID-19 pandemic recedes, retrogressive lobbying campaigns by organized medicine have already resurfaced, aimed at rolling back improvements in nursing practice authority that were long overdue…”.

Nurse practitioners couldn’t agree more with Dr. Sage’s assessment: It’s time to break the health care glass ceiling. It’s time to put patients first — and it’s time to enact FPA nationwide. Patients need access to care and our country needs a health care system that works for all of us. We invite our physician colleagues to work with us in expanding patient access to care — in rural, urban and suburban communities. Together, we can bolster primary care access, save lives, combat health care disparities, address chronic disease and reduce burnout for all health care providers.

April N. Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAA is president of the American Association of Nurse Practitioners® (AANP), the largest professional membership organization for nurse practitioners of all specialties.