Abstract
Background
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).
Methods
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%.
Discussion
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.
Conclusions
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.
Keywords
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Article info
Publication history
Published online: August 23, 2014
Accepted:
August 20,
2014
Received in revised form:
August 12,
2014
Received:
April 23,
2014
Footnotes
Supported by the The Robert Wood Johnson Foundation, Gordon & Betty Moore Foundation, and Johnson & Johnson Campaign for Nursing's Future.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
