Practice characteristics of primary care nurse practitioners and physicians



      Projections of physician shortages, an aging population, and insurance expansions have increased interest in expanding the number of primary care nurse practitioners (PCNPs) in the United States. Although information about the number and distribution of nurse practitioners is known, there is little information about the practice characteristics of PCNPs. The purpose of this study was to identify demographic and practice characteristics of PCNPs and compare these characteristics with primary care physicians (PCMDs).


      From November 23, 2011, to April 9, 2012, we conducted a national postal mail survey of 972 clinicians (467 PCNPs and 505 PCMDs). Questionnaire domains included compensation and billing practices; characteristics of patients treated; PCNPs' use of their own National Provider Identification number to bill services; how PCNPs spend their time; clinical and nonclinical activities performed; and whether PCNPs have privileges to admit, round on (i.e., oversee the care provided to) patients, and write orders independently of physicians. The response rate was 61.2%.


      PCNPs are more likely than PCMDs to practice in urban and rural areas, provide care in a wider range of community settings, and treat Medicaid recipients and other vulnerable populations. Not only do most PCNPs work with PCMDs, but also the majority of both clinicians believe that increasing the supply of PCNPs will result in greater collaboration and team practice. Although PCNPs and PCMDs deliver similar services and spend their time in nearly identical ways, PCNPs work less hours and see fewer patients, and only a handful of PCNPs have their salary adjusted for productivity and quality performance. PCNPs cite government and local regulations as impeding their capacity to admit and round on patients in hospitals and long-term care facilities and write treatment orders without a physician cosignature.


      Significant differences in demographic and practice characteristics exist between PCNPs and PCMDs. Whether working independently or with PCMDs, increasing the number of PCNPs can be expected to expand access to primary care, particularly for vulnerable populations, and for those gaining access to health insurance through the Affordable Care Act.


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      1. Association of American Medical Colleges. (2011). Physician shortages worsen without increases in residency training. Retrieved from

      2. Agency for Healthcare Research and Quality. (2013). The number of nurse practitioners and physician assistants practicing primary care in the United States. Retrieved from

        • Auerbach D.I.
        • Chen P.G.
        • Friedberg M.S.
        • Reid R.
        • Lau C.
        • Buerhaus P.I.
        • Mehrotra A.
        Nurse-managed health centers and patient-centered medical homes could mitigate expected primary care physician shortage.
        Health Affairs. 2013; 32: 1933-1941
        • Bodenheimer T.S.
        • Smith M.D.
        Primary care: Proposed solutions to the physician shortage without training more physicians.
        Health Affairs. 2013; 32: 1881-1886
        • Cooper R.A.
        Health care workforce for the twenty-first century: The impact of nonphysician clinicians.
        Annual Review of Medicine. 2001; 52: 51-61
        • DesRoches C.M.
        • Gaudet J.
        • Perloff J.
        • Donelan K.
        • Iezzoni L.
        • Buerhaus P.I.
        Using Medicare data to assess nurse practitioner–provided care.
        Nursing Outlook. 2013; 61: 400-407
        • Donelan K.
        • DesRoches C.
        • Dittus R.
        • Buerhaus P.
        Perspectives of physicians and nurse practitioners on primary care practice.
        New England Journal of Medicine. 2013; 368: 1898-1906
        • Dower C.
        • O'Neil E.
        Primary care health workforce in the United States. Research Synthesis Report 22.
        2011 (Retrieved from)
        • Fairman J.A.
        • Rowe J.W.
        • Hassmiller S.
        • Shalala D.E.
        Broadening the scope of nursing practice.
        New England Journal of Medicine. 2011; 364: 193-196
        • Green L.V.
        • Sergei S.
        • Yina L.
        Primary care physician shortages could be eliminated through use of teams, nonphysicians, and electronic communication.
        Health Affairs. 2013; 32: 11-19
      3. Graves, J., Mishra, P., Dittus, R., Parikh, R., Perloff, J., & Buerhaus, P. (2014). Health reform and the geography of the primary care workforce. Manuscript submitted for publication.

        • Health Resources and Services Administration
        • Bureau of Health Professions
        • National Center for Health Workforce Analysis
        Projecting the supply and demand for primary care practitioners through 2020.
        2013 (Retrieved from)
        • Health Resources and Services Administration
        • Bureau of Health Professions
        • National Center for Health Workforce Analysis
        Highlights from the 2012 National Survey of Nurse Practitioners.
        2014 (Retrieved from)
        • Horrocks S.
        • Anderson E.
        • Salisbury C.
        Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors.
        British Medical Journal. 2002; 324: 819-823
        • Iglehart J.K.
        Expanding the role of advanced nurse practitioners—Risks and rewards.
        New England Journal of Medicine. 2013; 368: 1935-1941
        • Institute of Medicine
        The future of nursing: Leading change, advancing health.
        National Academies Press, Washington, DC2010
        • Ku L.
        • Jones K.
        • Shin P.
        • Bruen B.
        • Hayes K.
        The state's next challenge—Securing primary care for expanded Medicaid populations.
        New England Journal of Medicine. 2011; 364: 493-495
        • Laurant M.
        • Reeves D.
        • Hermens R.
        • Braspenning J.
        • Grol R.
        • Sibbald B.
        Substitution of doctors by nurses in primary care.
        Cochrane Database of Systematic Reviews. 2005; 2: CD001271
        • Mundinger M.O.
        • Kane R.L.
        • Lenz E.R.
        • Totten A.M.
        • Tsa W.Y.
        • Cleary P.D.
        • Shelanski M.
        • et al.
        Primary care outcomes in patients treated by nurse practitioners or physicians: A randomized trial.
        Journal of the American Medical Association. 2000; 283: 59-68
        • National Governors Association
        The role of nurse practitioners in meeting increasing demand for primary care.
        National Governors Association, Washington, DC2012
        • Naylor M.D.
        • Kurtzman E.T.
        The role of nurse practitioners in reinventing primary care.
        Health Affairs. 2010; 29: 893-899
        • Newhouse R.P.
        • Stanik-Hutt J.
        • White K.M.
        • Johgntgen M.
        • Bass E.B.
        • Zangaro G.
        • Weiner J.P.
        • et al.
        Advanced practice nurse outcomes 1990-2008: A systematic review.
        Nursing Economics. 2011; 29: 230-250
      4. Park, M., Cherry, D., & Decker, S.L. (2011). Nurse practitioners, certified nurse midwives, and physician assistants in physician offices. Retrieved from

      5. Perloff, J, DesRoches, C, & Buerhaus, P. (2014). Comparing the cost of care provided to Medicare beneficiaries by primary care nurse practitioners and physicians. Manuscript submitted for publication.

        • Pohl J.M.
        • Hanson C.
        • Newland J.A.
        • Cronenwett L.
        Unleashing nurse practitioners' potential to deliver primary care and lead teams.
        Health Affairs. 2010; 29: 900-905
        • Reagan P.B.
        • Salsberry P.J.
        The effects of state-level scope-of-practice regulations on the number and growth of nurse practitioners.
        Nursing Outlook. 2013; 61: 392-399
        • Sackett D.L.
        • Spitzer W.O.
        • Gent M.
        • Roberts R.S.
        The Burlington randomized trial of the nurse practitioner: Health outcomes of patients.
        Annals of Internal Medicine. 1974; 80: 137-142
        • Venning P.
        • Durie A.
        • Roland M.
        • Roberts C.
        • Leese B.
        Randomised controlled trial comparing cost effectiveness of general practitioners and nurse practitioners in primary care.
        British Medical Journal. 2000; 320: 1048-1053