Why are more states expanding independent practice for nurse practitioners instead of increasing the number of MDs/DOs and offering more incentives for physicians who practice rural.


The nurse practitioner push for independent practice has been expanding. Recent data has shown that NPs bill more money to patients and provide a lower quality care than physicians. Why are states expanding independent practice rights for NPs instead of increasing medical school seats and offering more incentives for physicians to practice rurally?

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2 Answers

Anonymous 0 Comments

You don’t need an MD for everything, just like you don’t need an ER for everything.

NPs are much more cost-effective (at least on some jurisdictions) than MDs. They’re a nice middle ground between RNs and MDs for a lot of routine daily care that’s beyond what an RN is allowed to do but doesn’t require full MD capability.

Expanding NP independant practice rights can solve a problem (rural shortage of medical care in general) a lot faster than fattening the MD pipeline (which wont’ bear fruit for years) or changing incentives (which is just a subsidy for what’s still not cost-effective care in most cases).

Anonymous 0 Comments

Because Congress capped the number of new doctors that could be trained per year. Nurse Practitioners are a way around that cap.

“Before physicians practice medicine independently, they receive on-the-job training as residents in teaching hospitals.” [1]

“Medicare caps the number of residents it will fund per hospital based on how many residents it funded in 1996.” [1]

“Congress capped the number of residencies the program funds in 1997. ‘It was originally frozen as a response to lobbying from doctors who were complaining that there were too many doctors,’ Baker says. Trade groups for doctors have also been lobbying against allowing nurse practitioners, physician assistants and other medical professionals to play a larger role in treating patients. The result of policies like these, Baker argues, is a market with less competition, driving up prices for everyone.” [2]

1. https://www.gao.gov/products/gao-21-391
2. https://www.npr.org/sections/money/2019/03/12/702500408/are-doctors-overpaid