Nurse Practitioner Practice Regulations and Access to Primary Care

Background: 

Nurse Practitioner (NP) state practice regulations impede optimal and independent practice and negatively affect access to primary care particularly in geographic areas of the country where physician providers are not present. 

Methods:

GIS methods were used to geocode all primary care physicians (PCP) in the U.S. (N=241,618) as well as all American Association of Nurse Practitioners members (N=21,211) to assess the proportion of the population in each of the 3,143 counties in the U.S. that had a greater than 30 minute drive to the closest PCP or NP. Generalized linear models were estimated to determine the association of NP practice regulation on the population proportion with greater than a 30 minute drive time, controlling for geographic characteristics.

Results:

Compared to counties in states with restricted NP practice, the proportion of the population with a greater than 30 minute drive time was 11% lower in counties with reduced NP practice, and 17% lower in counties allowing full NP practice, although results were not statistically significant.

Conclusions:

Although not statistically significant, point estimates suggest that states with full NP scope of practice have a lower percentage of the population with a greater than 30 minute drive time to receive care when compared to states that restrict NP practice. NPs who are practicing in states that require physician supervision, are in essence tethered to physician practices, limiting their geographic distribution.  Allowing NPs full autonomy to practice may be a relatively simple way for states to improve access to primary care.