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A Practical Guide to Nurse Practitioners

These medical professionals are taking on more primary care

Nurse Practitioners: A Consumer's Guide

Ackerman + Gruber

Rebecca Bates is a nurse practitioner who treats uninsured patients at free clinics in Northern Virginia.

The math is worrisome: Demand for health care is rising due to an aging and growing population, but the supply of primary care physicians is declining. By 2030, the United States will have a shortage of as many as 43,100 primary care physicians, according to recent projections from the Association of American Medical Colleges. 

One solution? Nurse practitioners (NPs). These health professionals can perform many of the basic tasks that primary care doctors do — assess patients, diagnose diseases, order and interpret diagnostic tests (such as X-rays), develop care plans and prescribe medications. Some even perform minor surgical procedures. In 22 states and the District of Columbia, they can operate their own private practices without a physician’s oversight. All told, they can potentially fill a crucial gap in the health care system, especially in underserved areas. 

“We need more clinicians,” says Cindy Cooke, past president of the American Association of Nurse Practitioners (AANP) and an NP in Huntsville, Ala. “There is never a shortage of patients.”

There were roughly 222,000 nurse practitioners in the U.S. in 2016, and the number is rising. So chances are increasing that you’ll see a nurse practitioner at some point in your health care journey.

Nurse Practitioner Growth

Numbers of Nurse Practitioners in the U.S

Courtesy of American Association of Nurse Practitioners

The number of NPs in the United States has risen steadily, in part to help fill gaps left by an increasing physician shortage. And NPs are mostly focused on primary care. In 2016, according to the American Association of Nurse Practitioners, more than 80 percent of NPs trained in primary care programs. By comparison, 14.5 percent of physicians entered a primary care residency.

An NP is well trained — but not like a doctor

Becoming a nurse practitioner requires a bachelor’s degree in nursing, licensure as a registered nurse, a master’s degree and advanced clinical training. NPs also undergo national certification, peer review and clinical outcome evaluations, and they adhere to a code of ethics, according to the AANP. And then there’s this: Some 13 percent of NPs go on to obtain doctoral degrees, usually in some aspect of health care. Still, physicians spend more time in training than do NPs, which is a major difference between the two. Medical doctors obtain a four-year undergrad degree, spend four years in medical school and then three to seven years in residency. 

Nurse practitioners perform as well as physicians

In a study published in February in Medical Care, NPs and physician assistants delivered the same quality of care as doctors over a five-year period at community health centers. Patient outcomes for NPs were comparable or better than for physicians in 11 categories in a 2013 study published in the Journal for Nurse Practitioners. And in a study by the University of Michigan-Flint, patients rated nurse practitioners 9.8 out of 10 in satisfaction, while giving physicians an average score of 7.2.

Nurse practitioners are attuned to patients’ needs

Most NPs start their careers as registered nurses. That background makes them empathetic, attentive and good listeners, says Cooke. “We partner with patients. Knowing them well can guide discussions.” When Diana Drake, a nurse practitioner in Minneapolis and a University of Minnesota associate professor, asked a 70-year-old woman about any sexual concerns during a recent annual wellness exam, the patient thanked her. “You are the first provider to ask me about this and take the time to really listen,” the patient said. “Thank you for seeing me as a whole person.”

Nurse Practitioners: A Consumer's Guide

Ackerman + Gruber

Diana Drake is a nurse practitioner in Minneapolis and an associate professor at the University of Minnesota.

How nurse practitioners can practice varies by state

In February, South Dakota became the 22nd state to enact “full practice authority” for NPs. This means they can practice without supervision from physicians. In December 2016, the Department of Veterans Affairs also gave full practice authority to NPs and other advanced practice registered nurses in the VA health system, despite the objections of the American Medical Association, which represents physicians. NPs in the other 28 states are confined to “reduced” or “restricted” practice: They can provide care only if they collaborate with a physician. If that relationship ends, the NP can’t practice until establishing an agreement with a new physician. Physicians can also dictate what NPs can and can’t do.

An NP emphasizes prevention—not just treatment

Patients with chronic obstructive pulmonary disease who received care from NPs and other advanced practice registered nurses were less likely to visit the ER after hospitalization than those cared for by a physician, according to a 2016 study by the University of Texas Medical Branch in Galveston. “We tend to focus more on prevention and wellness — it’s a more holistic approach to health care,” says Penny Kaye Jensen, an NP with the Department of Veterans Affairs. Adds Rebecca Bates, an NP who works with uninsured patients at free clinics in Northern Virginia: “We are educated differently. We have different models of how we care for patients.”

Nurse practitioners face some resistance

The American Academy of Family Physicians, one of the largest doctors groups in the U.S., states on its website: “The nurse practitioner should not function as an independent health practitioner … [and] should only function in an integrated practice arrangement under the direction and responsible supervision of a practicing, licensed physician.” Care costs and avoidable hospitalizations are at their lowest when patients are treated by an optimal mix of primary care physicians, nurse practitioners and physician assistants, according to a report by the Robert Graham Center, a research organization that is aligned with the academy. But NP proponents say restricting their ability to practice without physician collaboration reduces competition. In states that have removed restrictions, NPs are more likely to work in rural and underserved areas, Bates says.

Ken Budd is a former health editor and executive editor of AARP The Magazine. He is the author of a memoir, The Voluntourist.

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