Nurse practitioners are key to accessible primary care

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Primary care practices that employ nurse practitioners (NPs) are significantly more likely to serve socioeconomically disadvantaged communities, according to a study published February 28 in JAMA Network Open by researchers at Columbia University School of Nursing.

The study, led by Monica O’Reilly-Jacob, PhD, an assistant professor at the university, analyzed 79,743 primary care practices across the United States and found that 53.4% employed NPs in 2023 — more than double the 21% reported in 2012. These practices with NPs were more often located in low-income (23.3% vs. 17.2%) and rural (11.9% vs. 5.5%) areas than those without NPs.

“This study demonstrates that NPs are increasingly utilized for primary care delivery across the country, and especially within low-socioeconomic communities,” O’Reilly-Jacob and her colleagues wrote. “This is important as fewer medical residents are choosing to practice primary care, resulting in an estimated shortfall of 20,200-40,400 primary care physicians by 2036.”

The findings underscore the industry’s growing reliance on NPs to address gaps in primary care availability, particularly in underserved areas, amidst the ongoing primary care shortage. The study found that communities where primary care practices employed NPs had more people living below the poverty level (14.4% vs. 12.8%) and lower levels of education, with more residents lacking high school diplomas (19.8% vs. 18.5%).

Researchers also noted a correlation between economic disadvantage and the presence of NPs. While there may be overall fewer primary care practices in low-income and rural communities, those that do exist are more likely to employ NPs — underscoring the crucial role they play in ensuring access to care for disadvantaged communities.

Policy implications

The study suggests that policymakers should take additional steps to support NPs in disadvantaged areas, “such as strengthening federal and state loan repayment programs, establishing pay parity in state Medicaid programs, and ensuring primary care provider designation for NPs across payers,” the study’s authors wrote, adding, “Such steps would expand the capacity of the primary care system to better meet demand in communities where it is needed most.”

With physician shortages expected to persist, NPs will likely continue playing a critical role in ensuring primary care access for underserved populations.