The “increased rural access” and “lower cost” rhetoric used to support nurse practitioner autonomy is a complete fallacy and there is zero data to support these claims.
1. The market factors that make it difficult for physicians to practice in rural, underserved areas is not any different for NPs than it is for physicians. NPs are not independently more altruistic than physicians. Poor payer mix and the expense of excessive regulatory burdens will make it difficult for anyone to keep their doors open in these areas.
2. Look at the states that have allowed NP independent practice for decades, like Arizona. NPs are practicing in the exact same places as physicians. They do not go to rural areas. There are maps available from AMA that show this quite clearly.
3. There are multiple studies that show NPs make more referrals to specialists, order more inappropriate radiology studies, and perform more skin biopsies than physicians. This all INCREASES cost to the healthcare system. In practice, I see NPs ordering tons of worthless tests in order to try to bridge the gaps in their knowledge. They order tests and then have no idea what to do with them which leads to more tests and more referrals. At a time when we are focused on decreasing unneeded healthcare waste, how does it make sense to use these undertrained non physicians.
4. If they are arguing for pay parity, how exactly do they decrease healthcare costs?
Data references demonstrating NPs increase cost and lower quality:
NPs order more biopsies: https://doc-10-58-docs.googleusercontent.com/docs/securesc/500pimnenqerpcb3jog4vu5k5j56276k/f3drubbtuuasggve85q8h4dmet2ru2n5/1570492800000/11904212300552749650/00862855625573411785/1Oa8BCwnGYyN8Qwxg4bk6NYPdEeaQETHw?e=download&nonce=5nnu0081r77o6&user=00862855625573411785&hash=rldhsra0pp9qca2lt28lrf0ccab5h8f2
NPs order more imaging:
NPs make more referrals to specialists: https://doc-0c-58-docs.googleusercontent.com/docs/securesc/500pimnenqerpcb3jog4vu5k5j56276k/pd0vv46pqfms4l8gfhefl9rtbjsjbnl9/1570492800000/11904212300552749650/00862855625573411785/1BYA0yZwLoHB0ozC8vOL6NVrHnDYj18MI?e=download
Prescribe more antibiotics =more antibiotic resistance:
More general resources https://drive.google.com/drive/mobile/folders/1FF7sTKg4XZa_L5mXpW2puGjlMU3BuwcO/1IwfXD0e5Lxk9BuJoPtD2egwQySsozxdS/1z-L86XfVOzW6KPFpolF13ltCEWrI3Vv5/1S3iJlDPUcGBiLZmVgK7CYolis8eiv41i?sort=13&direction=a