Nurse Practitioner Independence
By Jared Dashevsky, MD
New York officially granted nurse practitioners (NPs) Full Practice Authority (FPA), allowing them to provide a wide range of services without supervision. NPs in 25 states now have FPA. The FPA granted to NPs may help increase access to healthcare as the U.S. faces a formidable physician shortage.
“Full Practice Authority” means NPs can provide the full scope of services they’re educated and clinically trained to provide. These services include:
- Evaluating and diagnosing patients
- Ordering and interpreting diagnostic tests
- Initiating and managing treatments
- Prescribing medications
Although it may vary between states, NPs without FPA have to sign a contract agreement with a supervising physician to provide those above services.
By the Numbers
NPs can increase health care access, especially in rural communities where physician shortages are already a reality or imminent. The AAMC predicts we’ll have a shortage of physicians, between 37,800 and 124,000 physicians, by 2034.
- Physician employment is predicted to grow only 3% by 2030.
- NP employment growth, however, is predicted to grow 52% by 2030. WOW.
NP growth is likely due to the rapid expansion of NP programs. While around the same number of NP and medical students graduate each year, there are not enough residency programs for graduating med students (a huge bottleneck), which contribute to the physician shortage.
Advanced practitioners providing care at the “top of their license” is a highly contentious discussion in the medical field as health systems look for ways to cut costs. Yes, there is a shortage of physicians. Yes, NPs can take care of patients to address care gaps and do so at a lower cost than physician care. But, are there any boundaries? Even if NPs have FPA, should they care for complex patients or leave that to physicians? Better yet, how do we even categorize a patient as complex vs simple? Dr. Sachin Jain said something interesting in regards to “training at the top of your license”:
Complexity often lies in subtleties invisible to the untrained eye—and not all health professionals across and within professional groups are trained equally well to see those subtleties (in itself a controversial statement in some organizations).
So, if NPs have full practice authority, should they also go through additional years of mandatory post-graduate training (i.e., a residency), especially if they want to specialize? For some perspective, a family physician has at least five years and 15,000 clinical hours of additional training compared to NPs by the time they can both practice independently.
This is a complex topic. Health systems, at the least, need to invest in constructing boundaries delineating the care nurses, advanced practitioners and physicians provide to patients. The hope is that each group’s expertise can complement each other’s, leading to the best patient care possible.