Nurse practitioners (NPs) provide care in doctors’ offices and hospitals throughout the US. You might have an NP whom you see on a regular basis, or you might see an NP when your doctor’s schedule is booked solid. Can you trust a nurse practitioner to provide high quality care? Do they know what they are doing? Yes! No need to worry! Nurse practitioners are qualified and capable.
What exactly is a nurse practitioner?
NPs are well trained professionals who provide care in a variety of healthcare settings. Their emphasis is on the health and well-being of the whole person – focusing on health promotion, disease prevention, as well as health education and counseling. NPs have provided primary, acute and specialty healthcare to patients of all ages and walks of life for almost 50 years. Millions of patients see nurse practitioners for their care, and that number is likely to grow.
What kind of training does a nurse practitioner have?
Nurse practitioners receive extensive formal educations as well as clinical training. All NPs must complete a master’s or doctoral degree. In addition to a formal education, NPs must receive advanced clinical training and national certification. Moreover, NPs must undergo clinical outcome evaluations and periodic peer review and must adhere to a code for ethical practices.
Can a nurse practitioner work independently?
The answer to that depends on the state in which you receive your care because there are state laws and regulations that restrict the scope of practice for NPs. Because state laws differ significantly, there is a large variation in the care that NPs can provide. According to the American Association of Nurse Practitioners (AANP), there are 3 levels of practice allowed:
22 states allow all nurse practitioners to evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatments—including prescribing medications and controlled substances—under the exclusive licensure authority of the state board of nursing.
16 states reduce the ability of nurse practitioners by requiring a career-long regulated collaborative agreement with another health provider. NPs in these states have limits on the scope or setting for one or more elements of NP practice.
12 states restrict the ability of a nurse practitioner by requiring NPs to practice under the supervision of a doctor or other healthcare provider.
Wondering what the laws are in your state?
You can find out what limits NPs in your state face on the interactive map on the AANP website.
What kinds of healthcare settings do NPs work in?
NPs work in virtually every type of healthcare setting – hospital surgical departments, mental health facilities, urgent care centers, freestanding primary care offices and everything in between. Because over 193,000 NPs work in primary care, their positive impact in primary care medicine is significant for patients and primary care doctors alike.
Primary care practices really benefit from nurse practitioners!
Primary care is the foundation of the US healthcare system, providing treatment for common conditions and illnesses, as well as for accidents. Additionally, primary care provides preventive services and ongoing care for patients with chronic disease. In the US, primary care is designed to be a patient’s entry point into the healthcare system. For patients, having a primary care doctor improves the quality of their healthcare, and improves outcomes, care coordination and the patient experience. Moreover, collectively primary care contains costs, reduces unnecessary utilization, and promotes the efficient use of healthcare resources.
Primary health care doctors’ numbers are dwindling. And we should all be worried.
In the US, there is a shortage of primary care doctors, which is expected to worsen in coming years. A recent report by UnitedHealth group outlines the worrisome shortage:
- The supply of primary care doctors is, and will continue to be, insufficient to meet the demand of the population
- A primary care doctor with 2,000 patients would need to work an estimated 17.4 hours each day to provide recommended preventive, chronic, and acute care. It’s worth noting here that many primary care doctors have more than 2,000 patients. (Read my blog post to learn more about the overwhelming workload of primary care doctors: Is Your Primary Care Physician Overworked?)
The problem will likely worsen:
- Demand for primary care will increase significantly in the future as the US healthcare system serves a larger, older, and less healthy population.
- The shortage of primary care doctors may reach 49,000 in 2030, compared to 18,000 in 2018.
- In 2017, only one in six medical school graduates chose a primary care residency program.
Not all patients have reasonable access to primary care practices.
Everyone needs a primary care doctor to help them manage their health and healthcare. Unfortunately, that is almost impossible for many people in the US. A shortage of primary care doctors impacts both the insured and uninsured. Most noteworthy, the shortage impacts those living in rural, suburban and urban areas. As a result, healthcare for many is lacking. The UnitedHealth report describes the problems:
- 13% of US residents (44 million) live in a county with a shortage of primary care doctors (<1 primary care doctor/2,000 people).
- Rural residents are almost 5x more likely to live in a county with a primary care doctor shortage, compared to those living in urban and suburban areas (38 percent vs. 8 percent).
- Even though the percentages vary greatly, the density of populations in rural vs urban and suburban areas means that almost the same absolute number of urban and suburban residents (21 million) and rural residents (23 million) live in a county with a primary care doctor shortage.
Nurse practitioners to the rescue!
Seventy-eight percent, over >193,000 NPs, work in primary care practices. NPs help practices increase their capacity and thereby increase access to care. Some interesting statistics from the UnitedHealth report:
- By 2025, the number of NPs practicing in primary care will increase 47%.
- NPs are more likely than primary care doctors to practice in underserved communities, including rural areas. They’re also more likely to accept new patients.
- The quality of primary care delivered by NPs is comparable to care provided by doctors.
Everyone would benefit if states removed their restrictions.
Given the shortage of primary care doctors, and the important role NPs play in patient health in all clinical areas, we would all benefit from the easing of restrictions on NPs. The UnitedHealth report recommends that states remove their restrictive laws and allow NPs to practice to the full extent of their graduate education, clinical training and national certification. As a result of this change, there would be a significant increase in patients’ accessibility to primary care:
- The number of people living in counties with insufficient primary care access would decrease from 44 million to 13 million, a 70% reduction.
- The number of rural residents living in a county with a primary care shortage would decline from 23 million to 8 million, a 65 percent reduction.
As with any medical professional, there is a range of ability, experience and personality among nurse practitioners. When in an appointment with a nurse practitioner, I suggest you follow my recommendations outlined for all medical appointments in these blog posts:
- How Can You Get the Best Healthcare? Actively Participate!
- Being an Engaged Patient Can Help You Get the Best Medical Care Possible.
- 10 Tips for a Better Medical Appointment