Have Nurse Practitioners Reached a Tipping Point?: Interview of a Panel of NP Thought Leaders

Peter I. Buerhaus, PhD, RN, FAAN


Nurs Econ. 2010;28(5):346-349. 

In This Article


Buerhaus: Let's begin by focusing on NPs who practice in independent roles. To be clear, I am referring to NPs who are, or could be, competing directly with physicians for patients and market share. What is your estimate of the proportion of the nation's NPs who practice in independent roles and has this proportion been increasing or decreasing?

Esperat: Unfortunately, we do not have good data on the number of NPs engaging in these kinds of independent practices, or for that matter, in collaborative or complementary practice arrangements.

Pilon: It's difficult to answer this question because of the definition of independence. Physicians define independence as hanging out their shingle whereas NPs define independence as being free from regulation imposed by another profession. In Tennessee there has been a slight increase over the past 10 years in the number of NPs in solo practice or in partnership practice with another NP. But, where you see stronger growth involves the spread of nurse-managed clinics across the country. For example, Vanderbilt University School of Nursing operates 16 nurse-managed sites serving 20,000 unique patients. Ten years ago that number was 5,000. But, these nurse-managed clinics are not competing in any way with physicians in those markets.

Hanson: I know two NPs who bought the rural practices of physicians who were ready to retire. The physicians ended up working for the NPs and the arrangement has been very successful. Overall, I don't believe there is that much true competition between NPs and physicians in the sense you indicated in your question, especially in primary care and in rural communities. Rather, I see more complementary practice.

Buerhaus: Can you elaborate on the payment issues facing NPs?

Barton: One of the barriers that NPs have faced in growing their practices and increasing market share is the resistance of third-party payers to recognize NPs as independent providers and to pay them accordingly.

Hansen-Turton: Every 2 years the National Nursing Centers Consortium conducts a survey of insurance companies in the country. According to the results of the most recent survey, in July 2009, 52% of insurance companies allowed contracting for NPs as primary care providers. A few years ago this percentage was only 30% and 6 years ago was just 20%. Also, Aetna recently recognized NPs as primary care providers (if they are fully credentialed) which provides a lot of positive visibility. Although there is increasing recognition of NPs by private insurers, it is not as close to 100% recognition that I believe is needed for NPs to be players at the national level with respect to implementing health care reform. We had a preview of this when, following the implementation of health reform in Massachusetts, there were not enough providers to take care of the primary care population. Consequently, the governor got everybody together and in less than 1 year there was a new law in effect which requires state health care plans to contract and credential NPs.