Does Scope of Practice Affect Mobility of Nurse Practitioners Serving Medicare Beneficiaries?

Abstract

The shortage of nurse practitioners (NPs) in the United States has broadly decreased access, decreased quality, and increased cost of care for an aging population in both metro and rural areas. Some state policymakers are trying to address the shortage by expanding NPs' scope of practice (that is, their autonomy to order tests, to prescribe medications, to diagnose patients, and to initiate and manage treatments). We estimate the impact of expanded NP scope of practice on the mobility decisions of NPs serving Medicare beneficiaries. Since these expansions have been at the state level, it is important for policy evaluation to know whether the legal differences in NPs' roles affect where they decide to both live and practice. We identify NPs' location decisions between 2014 and 2017 by gleaning their National Provider Identifiers from Part D Prescriber Public Use File data. Then we examine whether NPs' movement from restrictive-practice to full-practice states increased over time. We find that in a given year, NPs in restrictive-practice states are both 0.46 percent more likely to move out of state (compared to NPs in other states) and 5.33 percent less likely to move to other restrictive states than to nonrestrictive states. Our estimates demonstrate NPs' preference for practicing in states with full scope of practice.