{"id":121952,"date":"2025-08-05T21:57:18","date_gmt":"2025-08-05T21:57:18","guid":{"rendered":"https:\/\/www.europesays.com\/us\/121952\/"},"modified":"2025-08-05T21:57:18","modified_gmt":"2025-08-05T21:57:18","slug":"harnessing-the-capacity-of-nurse-practitioners-to-increase-access-to-primary-care-in-disadvantaged-communities","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/us\/121952\/","title":{"rendered":"Harnessing the Capacity of Nurse Practitioners to Increase Access to Primary Care in Disadvantaged Communities"},"content":{"rendered":"\n

Primary care in the United States is in dire straits. Every year, it seems the national primary care scorecard<\/a> is more sobering than the year before: more and more patients are going without a usual source of care, while fewer and fewer residents are choosing to practice primary care. It\u2019s even tougher in rural<\/a> and low-income<\/a> communities, where easy access to primary care could bring the most benefit. Amidst the gloom and doom, there is a glimmer of hope. \u00a0\u00a0<\/p>\n

The number of nurse practitioners (NPs) \u2014 a profession first introduced\u00a0in the 1960s to address a primary care shortage in the rural west \u2014 is growing rapidly. In fact, they are among the fastest growing professions (behind\u00a0only renewable energy technicians<\/a>). The number of NPs\u00a0quadrupled from 91,000 in 2007<\/a> to 431,000 in 2024,<\/a> outpacing prior projections<\/a> at a growth rate\u00a0(46%) that far exceeds the national average occupation growth<\/a> rate (4%). \u00a0<\/p>\n

But does this remarkable growth result in improved access to primary care where it is needed most? NPs, overall, seem to gravitate towards rural<\/a> and low-income<\/a> areas, but is this also true of primary care NPs?<\/p>\n

Are Primary Care NPs Likely to Practice in Rural and Low-Income Areas?<\/p>\n

This question is surprisingly difficult to answer because distinguishing between primary care and specialty care NPs is a challenge<\/a> in commonly used big datasets, like Medicare claims.<\/p>\n

We set out to answer this question<\/a> with IQVIA OneKey, a unique national 2023 dataset of primary care practices, with and without NPs. We used Census data to examine the socioeconomic characteristics of neighborhoods (i.e., Census tracts) where the practices were located, including the Area Deprivation Index (ADI), an overall measure of socioeconomic disadvantage.\u00a0We then compared the differences between communities with primary care practices that employed NPs with those that did not employ NPs.<\/p>\n

We found that in 2023, 53.4% of all primary care practices in the U.S. employed an NP, up from 21% in 2012.<\/a> We also found that primary care practices with NPs, compared to those without, were more likely to be in rural areas and communities of\u00a0socioeconomic disadvantage.\u00a0In fact, there was a consistent pattern: as socioeconomic disadvantage increased, primary care practices were more likely to employ NPs (Figure 1). For example, in communities with the lowest decile ADI (i.e., least disadvantage), 33.4% of practices employed NPs. In contrast, in communities with the highest ADI (i.e., most disadvantaged), 66.0% of practices employed NPs.\u00a0<\/p>\n

Not surprisingly, communities with greater socioeconomic disadvantage had fewer primary care practices. But as the overall supply declined, primary care practices with NPs represented an increasingly larger share \u2013 particularly in the Southeast (Figure 2). These results confirm a long-standing assumption: NPs are key to improving access to primary care in the most disadvantaged communities.<\/p>\n

Figure 1. Comparison of the Area Deprivation Index (ADI) Between Communities with Primary Care Practices with or without NPs\u00a0<\/strong><\/p>\n

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Figure 2. Distribution of the Number of Primary Care Practices in Low-Income Census Tracts with or without NPs, per 100,000 People Across Census Divisions<\/strong><\/p>\n<\/p>\n

NP Practice Barriers<\/p>\n

Despite the importance of NPs to increasing access to primary care in disadvantaged areas, there are multiple layers of practice barriers<\/a> (i.e., federal, state, organizational and payer) that restrict NP care. These barriers require physician supervision of NPs (such as periodic review of documentation and co-signature on orders and prescriptions) and often create administrative burden for both NPs and physicians. This time spent on paperwork takes time away from direct patient care, and when supervision requirements are removed, both NPs and physicians see more patients<\/a>.<\/p>\n

Required supervision of NPs does not improve quality of care or population health<\/a>. NPs consistently provide high-quality, evidence-based care<\/a> and organically collaborate in team-based care models with or without a mandate<\/a>. In the context of a projected shortfall of up to 40,000 primary care physicians by 2036<\/a>, this is wonderful news. But state policymakers can advance policies that allow NPs to most effectively meet the primary care needs of underserved communities. To that end, we recommend a multi-pronged policy approach:<\/p>\n