Abstract:
In 1965, the nurse practitioner profession began in response to a shortage of primary care providers in urban and rural areas. States began recognizing advanced practice nurse providers who completed certificate or post graduate training programs for advanced practice to diagnose and treat health conditions under various levels of physician supervision. Today, over 25 million people live in areas designated as rural primary care health professional shortage areas where it is still difficult to get timely access to health services. The National Governor’s Association, advocates for nurse practitioners, and researchers have suggested that more effective incorporation of nurse practitioner services and easing restrictions to practice could mitigate the growing shortage and/or maldistribution of primary care physicians, reduce geographic disparities, and improve access to primary care services. Over time, some states have amended their nurse practice acts to allow nurse practitioners more independent practice with the intent to increase the supply of primary care providers and improve access to care (especially in rural and underserved areas). Research studies conducted to date provide limited understanding about the relationship between state nurse practice act changes on the growth and distribution in the supply of nurse practitioners as primary care providers. This dissertation employed a difference-in-differences design to exploit variation in timing of changes in state scope of practice laws (from more restrictive to less restrictive) to study the causal effects on the supply of nurse practitioners at the county level. The results of this study found states that authorized nurse practitioners to practice independently saw a 17.5 percent decrease in the number of nurse practitioners at the county level and a 12.5 percent decrease in rural counties. We found the supply of nurse practitioners continued to decline 7 years after adoption of full scope of practice regulation in two states.
