Growth in retail-based clinics after nurse practitioner scope of practice reform

Published:November 16, 2016DOI:


      • Scope of practice (SOP) policies may influence efforts to increase access to care.
      • Our findings suggest a link between SOP and retail clinic growth.
      • Our results using a regional analysis suggest the need for a national scale study.



      Retail clinics are largely staffed by nurse practitioners (NPs) and are a popular destination for nonemergent care.


      We examined if there was a relationship between NP practice regulations and retail clinic growth after the passage of a scope of practice (SOP) reform bill in Pennsylvania.


      General linear regression models were used to compare retail clinic openings in Pennsylvania, New Jersey, and Maryland between 2006 and 2013.


      From 2006 to 2008, Pennsylvania experienced a significant growth rate in net retail clinic openings per capita (p = .046), whereas New Jersey and Maryland experienced no significant increase (p = .109 and .053, respectively). From 2009 to 2013, Pennsylvania opened 0.20 clinics (p = .129), New Jersey opened 0.23 clinics (p = .086), and Maryland opened 0.34 clinics per capita per year (p = .017).


      Our study of three states with varying levels of SOP restraint reveals an association between relaxation of practice regulations and retail clinic growth.


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      1. American Association of Nurse Practitioners, 2013, State Practice environment. Retrieved from

        • Bachrach D.
        • Frohlick J.
        • Garcimonde A.
        • Nevitt K.
        Building a culture of health: The value proposition of retail clinics.
        Robert Wood Johnson Foundation, St. Louis, Missouri2015 (Retrieved from)
        • Battaglia L.E.
        Supervision and collaboration requirements: The vulnerability of nurse practitioners and its implications for retail health.
        Washington University Law Review. 2009; 87: 1127
        • Chang J.E.
        • Brundage S.C.
        • Bruke G.C.
        • Chokshi D.A.
        Convenient care: Retail clinics and urgent care centers in New York State.
        United Hospital Fund Special Report, New York, NY2015
        • Institute of Medicine
        The future of nursing: Leading change, advancing health.
        National Academies Press, Washington, DC2010 (Retrieved from)
        • Chollet D.
        Increasing access to urgent care in Pennsylvania, report to the Governor's office of health care reform.
        Mathematica Policy Research, Princeton, NJ2006
        • Dill M.J.
        • Pankow S.
        • Erikson C.
        • Shipman S.
        Survey shows consumers open to a greater role for physician assistants and nurse practitioners.
        Health Affairs. 2013; 32: 1135-1142
        • Dyson R.P.
        New law offers Expanded Role for Nurse Practitioners.
        (Southern Maryland Online)2010 (Retrieved from)
        • Gilman D.J.
        • Koslov T.I.
        Policy perspectives: Competition and the regulation of advanced practice nurses.
        Federal Trade Commission, Washington, DC2014 (Retrieved from)
      2. H.R. 319, 2010 Reg. Sess. (Md. (2010)).

      3. H.R. 699, 2006 Reg. Sess. (Fl. (2006)).

      4. H.R. 1253, Reg. Sess., 2007–2008. (Pa. (2007)).

      5. H.R. 1885, 95th Gen. Assem., (Ill. (2007)).

        • Hsu A.
        Legal issues concerning retail clinics.
        Health Lawyer. 2008; 20: 13-28
        • Japsen B.
        As Obamacare rolls out, retail clinics are booming again. Forbes.
        2013 (Retrieved from)
        • Kaissi A.
        • Charland T.
        The evolution of retail clinics in the United States, 2006-2012.
        The Health Care Manager. 2013; 32: 336-342
        • Kuo Y.F.
        • Loresto F.L.
        • Rounds L.R.
        • Goodwin J.S.
        States with the least restrictive regulations experienced the largest increase in patients seen by nurse practitioners.
        Health Affairs. 2013; 32: 1236-1243
        • 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; 18: CD001271
        • Mehrotra A.
        • Lave J.R.
        Visits to retail clinics grew fourfold from 2007 to 2009, although their share of overall outpatient visits remains low.
        Health Affairs. 2012; 31: 2123-2129
        • Merchant Medicine
        Building the ideal team: High turnover is no longer an option in the competitive walk-in world.
        Merchant Medicine, Shoreview, MN2014
      6. N.J. Stat. (n.d.). Ann. § 45:11–49.

        • Pennsylvania Department of Health
        State health improvement plan 2006 to 2010.
        Pennsylvania Department of Health, Harrisburg, PA2006
        • Phillips S.J.
        Nineteenth annual legislative update: A comprehensive look at the legislative issues affecting advanced nursing practice.
        The Nurse Practitioner. 2007; 32: 19-42
        • Pollack C.E.
        • Armstrong K.
        The geographic accessibility of retail clinics for underserved populations.
        Archives of Internal Medicine. 2009; 169: 945-949
        • Rendell E.G.
        Prescription for Pennsylvania. Right state, right plan.
        Office of the Governor, Harrisburg, PA2007
        • Robert Wood Johnson Foundation Initiative on The Future of Nursing
        Prescription for Pennsylvania: Case studies about leadership, practice.
        2015 (Retrieved from)
        • Rozga K.
        Retail health clinics: How the next innovation in market-driven health care is testing state and federal law.
        American Journal of Law & Medicine. 2009; 35: 205-231
        • Rudavsky R.
        • Pollack C.E.
        • Mehotra A.
        The geographic distribution, ownership, prices, and scope of practice at retail clinics.
        Annals of Internal Medicine. 2009; 151: 315-320
      7. S. 484, 2010. Reg. Sess. (Md. (2010)).

        • Schiff M.
        The role of nurse practitioners in meeting increasing demand for primary care.
        National Governors Association, Washington, DC2012
        • Schleiter K.E.
        Retail medical clinics: Increasing access to low-cost medical care amongst a developing legal environment.
        Annals of Health Law. 2009; 19: 527-575
        • Scott M.K.
        Health care in the express lane: Retail clinics go mainstream.
        California HealthCare Foundation, Oakland, CA2007 (Retrieved from)
        • Spetz J.
        • Parente S.T.
        • Town R.J.
        • Bazarko D.
        Scope-of-practice laws for nurse practitioners limit cost savings that can be achieved in retail clinics.
        Health Affairs. 2013; 32: 1977-1984
        • Thygeson M.
        • Van Vorst K.A.
        • Maciosek M.V.
        • Solberg L.
        Use and costs of care in retail clinics versus traditional care sites.
        Health Affairs. 2008; 27: 1283-1292
      8. Traczynski, J., & Udalova, V. (2013). Nurse practitioner independence, health care utilization, and health outcomes. Paper presented at Fourth Annual Midwest Health Economics Conference, Madison, WI. April 2013.

        • Tu H.T.
        • Boukus E.R.
        Despite rapid growth, retail clinic use remains modest [brief no. 29].
        Center for Studying Health System Change Research, Washington, DC2013 (Retrieved from)
        • Tu H.T.
        • Cohen G.R.
        Checking up on retail-based health clinics: Is the boom ending?.
        Commonwealth Fund, New York, NY2008 (Retrieved from)
        • University of Pennsylvania Almanac
        Governor Rendell's prescription for Pennsylvania: Signing health care reform measures into law.
        Journal of Record, Opinion and News. 2007; 54 (5. Retrieved from)
        • US Census Bureau
        American FactFinder Glossary: Block Group (BG).
        US Census Bureau, Washington, DC2013 (Retrieved from)
        • Weinick R.M.
        • Burns R.M.
        • Mehrotra A.
        Many emergency department visits could be managed at urgent care centers and retail clinics.
        Health Affairs. 2010; 29: 1630-1636
        • Xue Y.
        • Ye Z.
        • Brewer C.
        • Spetz J.
        Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review.
        Nursing Outlook. 2016; 64: 71-85
        • Yee T.
        • Boukus E.
        • Cross D.
        • Samuel D.
        Primary care workforce shortages: Nurse practitioner scope-of-practice laws and payment policies [NIHCR research brief no. 13].
        National Institute for Health Care Reform, Washington, DC2013 (Retrieved from)