Supply Of Nurse Practitioners Research Articles

Relationship between rural hospital closures and the supply of nurse practitioners and certified registered nurse anesthetists

BackgroundReductions in primary care and specialist physicians follow rural hospital closures. As the supply of physicians declines, rural healthcare systems increasingly rely on nurse practitioners (NPs) and certified registered nurse anesthetists (CRNAs) to deliver care. PurposeWe sought to examine the extent to which rural hospital closures are associated with changes in the NP and CRNA workforce. MethodUsing Area Health Resources Files (AHRF) data from 2010-2017, we used an event-study design to estimate the relationship between rural hospital closures and changes in the supply of NPs and CRNAs. FindingsAmong 1,544 rural counties, we observed 151 hospital closures. After controlling for local market characteristics, we did not find a significant relationship between hospital closure and the supply of NPs and CRNAs. DiscussionWe do not find evidence that NPs and CRNAs respond to rural hospital closures by leaving the healthcare market.

Beyond Physicians: The Effect of Licensing and Liability Laws on the Supply of Nurse Practitioners and Physician Assistants

The increased use of nurse practitioners (NPs) and physician assistants (PAs) represents an important option for increasing access to healthcare. I explore the effect of two types of laws on the supply of NPs and PAs: occupational licensing laws that limit the practices of NPs and PAs and caps on noneconomic damages. Relaxing licensing laws to allow NPs to practice with less physician oversight increases the supply of NPs in areas with few practicing physicians by 60 percent—though the size of this increase decreases as the supply of physicians grows. I find similar, but weaker, evidence for granting PAs more autonomy. Noneconomic damages caps increase the supply of both NPs and PAs by about 60 percent at the lowest levels of physician supply. Examining the effects of these laws on the prevalence of health professional shortage areas, I find that licensing laws have meaningful effects on access to care.

Beyond Physicians: The Effect of Licensing and Liability Laws on the Supply of Nurse Practitioners and Physician Assistants

Beyond Physicians: The Effect of Licensing and Liability Laws on the Supply of Nurse Practitioners and Physician Assistants

Full Scope-of-Practice Regulation Is Associated With Higher Supply of Nurse Practitioners in Rural and Primary Care Health Professional Shortage Counties

Introduction Access to quality primary care is challenging for rural populations and individuals residing in primary care health professional shortage areas (HPSAs). The ability of nurse practitioners (NPs) to provide full care is governed by state scope-of-practice (SOP) regulation, which is classified into three types: full SOP, reduced SOP, and restricted SOP. Understanding how legislative and regulatory decisions can influence supply of NPs in underserved areas can help guide effective health policies to reduce disparities in access to care. Objective To investigate the trends in NP supply in rural and primary care HPSA counties and their relationship with SOP regulation. Methods The authors conducted longitudinal data analyses using an integrated county-level national data set from 2009 to 2013. A hierarchical mixed-effects model was performed to assess the relationship between state SOP regulation and NP supply in rural and primary care HPSA counties. Results The number of NPs per 100,000 population increased in rural and primary care HPSA counties across states with various types of SOP regulation between 2009 and 2013. Compared with the NP supply in rural or primary care HPSA counties in states with reduced or restricted SOP regulation, NP supply in those counties in states with full SOP regulation was statistically significantly higher. Conclusions State full SOP regulation was associated with higher NP supply in rural and primary care HPSA counties. Regulation plays a role in maximizing capacity of the NP workforce in these underserved areas, which are most in need for improvement in access to care. This information may help inform state regulatory policies on NP supply, especially in underserved areas.

Beyond Physicians: The Effect of Licensing and Liability Laws on the Supply of Nurse Practitioners and Physician Assistants

The increased use of nurse practitioners (NPs) and physician assistants (PAs) represents an important option for increasing access to healthcare. I explore the effect of two types of laws on the supply of NPs and PAs: (1) occupational licensing laws that limit the practices of NPs and PAs and (2) caps on noneconomic damages. I find that relaxing licensing laws to allow NPs to practice with less physician oversight increases the supply of NPs in areas with few practicing physicians by 60 percent — though the size of this increase decreases as the supply of physicians increases. I find a similar effect of licensing laws that grant greater PA autonomy on the supply of PAs, but this effect is not consistently statistically significant. Noneconomic damages caps increase the supply of both NPs and PAs by about 60 percent at the lowest levels of physician supply, but the size of this increase decreases as the physician supply grows. I also examine the effects of these laws on the probability that a county contains a health professional shortage area. The results of this analysis indicate that licensing laws have meaningful effects on access to care.

Appendices to 'Beyond Physicians: The Effect of Licensing and Liability Laws on the Supply of Nurse Practitioners and Physician Assistants'

Appendix A and Appendix B to Beyond Physicians: The Effect of Licensing and Liability Laws on the Supply of Nurse Practitioners and Physician Assistants.

Primary health care nurse practitioners in Canada

Canada, like many countries, is in the midst of primary health care reform. A key priority is to improve access to primary health care, especially in remote communities and areas with physician shortages. As a result, there is an increased emphasis on the integration of primary health care nurse practitioners. As of March 2006, legislation exists in all provinces and two territories in Canada that allows nurse practitioners (NPs) to implement their expanded nursing role. In this paper, we will briefly review the historical development of the NP role in Canada and situate it in the international context; describe the NP role, supply of NPs in the country, and the settings in which they work; propose an NP practice model framework; summarize facilitators and barriers to NP role implementation in primary health care delivery; and outline strategies to address the barriers.

The Supply of Primary Care Physician Assistants and Nurse Practitioners in Underserved North Carolina

In the debate about a pending physician shortage it is timely to turn policy attention to the effect that the growing supply of physician assistants (PAs) and nurse practitioners (NPs) will have on physician workforce projections. The only comprehensive national data set on the nursing workforce in the United States is the National Nursing Sample Survey and data from that survey reveal that the number of NPs in the US has more than tripled over the past 20 years, increasing 223% from 15,443 in 1980 to 49,876 in 2000.1 Nationally, the number of PAs in practice has grown 354% over the same period from 8,916 PAs in 1980 to 40,469 in 2000.2 By contrast, during the same period, the number of physicians in the US increased 47%, from 519,000 in 1983 to 761,000 in 2001.3 Data from North Carolina tend to mirror these national workforce trends. Since the early 1990s, the growth in physician supply has been modest compared to that of NPs and PAs. Between 1990 and 2003, the ratio of physicians to population increased 26%, while the ratio of PAs and NPs to population increased 132% and 214%, respectively. Much of the growth of NP and PA supply has been in rural and underserved areas of the state. For every 100 physicians practicing in a county designated as a whole county persistent health professional shortage area (PHPSA) in 2003, there were 20 NPs, a substantial increase from 1990 when only 7 NPs per 100 physicians were practicing. Similarly, 21 PAs for every 100 physicians were practicing in whole county PHPSAs in 2003, up from 7 per 100 physicians in 1990. This increase in NP and PA supply relative to physicians in counties that consistently face difficulties recruiting health professionals suggested that a considerable portion of primary care in North Carolina is provided to patients by NPs or PAs.4 National data supported this supposition. Findings from an analysis of the 1995-1999 National Ambulatory Medical Care Surveys indicated that approximately 25% of primary care office-based physicians use PAs and NPs and that both are more greatly utilized in rural areas.5 Although a few studies have cited the growing supply of NPs and PAs relative to physicians, little research exists specifically on the supply and distribution of primary care PAs and NPs on the state level. The difficulty in estimating the percentage of NPs and PAs engaged in primary care has hindered attempts to model the primary care workforce, particularly in nonmetropolitan areas. Nationally, approximately half of all PAs report a primary care specialty.6 In North Carolina, 41% of PAs and 56% of all actively practicing NPs report a primary care specialty. This brief report focuses on the supply, geographic distribution, and specialty and employment characteristics of primary care NPs and PAs in North Carolina, with a specific focus on rural and health professional shortage areas. The Abstracts and Brief Reports section publishes short, focused communications on a research endeavor relevant to PA education or behavior. Submissions should be limited to approximately 1,500 words and one or two exhibits (tables or illustrations). The intent of this feature is to promulgate new information and provide a platform for additional research. Authors desiring to contribute to Abstracts and Brief Reports should forward submissions (with a copy to journal staff at jpae@PAEAonline.org) to: