Closing the Gap with Nurse Practitioners

Written by: Saradha Miriyala
Edited by: Julienne Chaquor

Prompt care should be an inalienable right in healthcare; there is no reason that anyone should not have access to care whenever they need it, wherever they are. However, the reality for many Americans, especially those that live in rural areas, is that access to healthcare can be very difficult to obtain. In fact, 20% of American citizens live in rural America, but they are only served by 9% of America’s doctors [3]. This is an alarming statistic, especially considering that citizens in rural areas may need to travel great distances to see doctors for potentially time-sensitive care, and doctors may be overwhelmed by a heavier patient workload. To solve this issue, the most obvious solution would be, “why not send more doctors to these area?” But who says that doctors are they only people that can rise to the occasion?

California recently made waves in the medical community when it announced that it would be changing state laws to allow nurse practitioners full authority to practice independently by 2023 [2]. While only 9% of doctors live in rural areas, 17-18% of nurse practitioners reside in rural areas and have been shown to run successful practices, so they would be more equipped in number to successfully support these areas [3]. While giving nurse practitioners autonomy seems like the obvious solution, critics cite concerns regarding the differences in education between doctors and nurse practitioners.

Normally a physician is required to go through years of training, and typically earn an undergraduate degree, a doctorate in allopathic (MD) or osteopathic (DO) medicine, and several years of residency. On the other hand, the minimum education for nurses includes just four years of undergraduate education for a degree in nursing [2]. However, it is a gross misconception that nurse practitioners fit this mold. All nurse practitioners have at least a bachelors in nursing, but most also pursue a masters in nursing (MSN), post-masters NP certificates, or doctor in nursing practice (DNP) degrees. In fact, nurse practitioners must not only complete a masters degree, but also meet state licensing requirements, pass a certification exam, and even specialize in areas such as family care or pediatrics [1]. 

California is not the first state to take this step. California will be joining the current cohort of twenty-three states that allow independent practice [5]. This is a drastic difference from states in which nurse practitioners do not yet have autonomy and work under several restrictions, where they cannot open their own practices, prescribe controlled substances, or work outside the supervision of a physician [5].

In fact, there are many advantages of allowing nurse practitioners full autonomy and improving the quality of healthcare in America beyond relieving the healthcare crisis in rural America. Nurse practitioners will be able to offer more affordable care, as “NPs provided… care at a lower total cost than physicians” [4]. However this does not mean that their quality of care is any different than doctors. In fact, “of more than 100 published, post-OTA reports on the quality of care provided by both nurse practitioners and physicians, not a single study has found that nurse practitioners provide inferior services within the overlapping scopes of licensed practice” [1]. 

Healthcare in America is not up to the standards that it should meet, and measures should be taken to improve it. The first step in this process may be to allow nurse practitioners, who are capable and eager to answer the call, to provide the quality care they have always been providing. 

Works Cited:

1. Bauer JC. Nurse practitioners as an underutilized resource for health reform: Evidence‐based demonstrations of cost‐effectiveness [Internet]. 2010 [cited 2020Nov8]. Available from: https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1745-7599.2010.00498.x 
   
2. Brusie BC. California Grants Nurse Practitioners Full Practice Authority by 2023 [Internet]. [cited 2020Nov8]. Available from: https://nurse.org/articles/california-nurse-practitioners-full-practice/ 
   
3. Doctor-starved: America's heartland in crisis [Internet]. [cited 2020Nov8]. Available from:https://money.cnn.com/2010/03/26/news/economy/health_care_rural_care_country_doctors/index.htm 
   
4. Nurse Practitioner Cost Effectiveness [Internet]. [cited 2020Nov8]. Available from: https://www.aanp.org/advocacy/advocacy-resource/position-statements/position-statements 
   
5. Nurse Practitioner vs. Doctor: A Side-by-Side Comparison [Internet]. 2020 [cited 2020Nov8]. Available from: https://www.nursepractitionerschools.com/faq/np-vs-doctor/