It’s Time to Fix What Ails Us

When Dr. Henry Silver and I founded the first nurse practitioner (NP) program in 1965, we knew NPs, given advanced preparation, could practice autonomously. For the benefit of patients who lack access to care or a choice of provider, it’s beyond time to make direct access to NP care a reality.

Today, 270,000 NPs are transforming health care access for millions of patients in over 1 billion visits annually. Yet, despite over 50 years of outstanding patient care delivered by NPs, outdated laws in 28 states prevent NPs from working at the top of their professional preparation. As a result, 80 million Americans nationwide remain “landlocked” in health care deserts where there is inadequate access to primary care.   

The access challenge is particularly problematic for patients in rural areas, where they are “almost five times as likely to live in a county with a primary care physician shortage compared to urban and suburban residents,” according to a 2018 UnitedHealth Group report.

More than 85 percent of NPs are trained in primary care areas, including pediatric, adult and geriatric care – critical to the health of our aging baby boomers. NPs also treat patients like women’s health, veterans, those fighting opioid use disorder, patients living with HIV, and many others. NPs’ whole-person orientation promotes wellness and prevention, strengthening patient outcomes and encouraging patients to take control of their health. From private practice to retail clinics, hospitals to the VA health system, NPs are now a vital part of all types of health care teams and the primary care provider of choice for millions of Americans. 

In 22 states and the District of Columbia, NPs have full practice authority, enabling them to provide primary care services without unnecessary physician oversight. NPs evaluate and diagnose patients, order and interpret diagnose tests, and prescribe medications in all 50 states. The remaining 28 states impose restrictions on the care NPs can provide. In these states, NPs require a “permission slip” from a physician in the form of a contract, and often for a fee, to legally treat patients. 

It’s no surprise that states with restricted scope of practice laws have 40 percent fewer members of the profession than states with full practice authority. Eight of the top ten healthiest states in the nation grant full practice authority to NPs, while the 10 least healthy states all strict patient access to NP care.

Research shows that 70% of Americans want the ability to choose an NP as their primary care provider, and the majority support full practice authority for NPs. 

From the founding of our profession, studies have demonstrated the outstanding patient outcomes NPs deliver – equal to and in some cases better than our physician colleagues.  Patients give NPs outstanding marks for their care. Recently, a study of Medicare enrollees treated by NPs in the journal Medical Care found NPs had lower rates of preventable hospital admissions, hospital readmissions, and inappropriate emergency-room visits than those treated by physicians.  

Beyond patients, the National Academy of Medicine, the National Governors Association, the Federal Trade Commission, and the administration have called for lifting barriers to NP practice. In fact, most recently, the administration has called for granting Medicare patients direct access to NP care. 

In my 99 years, I have treated WWII service members in war and babies in rural, make-shift clinics. I have witnessed white coat graduations of NPs trained in our nation’s first NP doctoral program and watched the profession grow to 270,000 strong. Today, I believe more than ever, it is time to solve what ails our country: access to care. Policymakers and patients have the power to strengthen access with their voice and their vote – and NPs have the power to deliver the accessible, high-quality care all patients deserve.

Loretta C. Ford, EdD, RN, PNP, FAAN, FAANP is a former military and rural public health nurse who co-founded the nation’s first nurse practitioner program.