How Different Is Care Delivered By Docs vs. NPs?

By Bianca Frogner, PhD
October 2, 2020

Earlier this week, California Gov. Gavin Newsom signed a law that paves the way for nurse practitioners (NPs) to practice independently of physicians. Florida Gov. Ron DeSantis did the same back in March.

Both laws come after years of heated debates. Proponents of expansion argue this change will improve patient access to primary care in communities that are otherwise underserved such as rural areas. Opponents argue that NPs are not a substitute for physicians given the difference in years of training. Many states still limit NPs’ abilities to practice on their own, and to inform these ongoing debates, researchers have been comparing the services provided by NPs and physicians.
Researchers Hannah Neprash, Laurie Barrie Smith, Bethany Sheridan, Katherine Hempstead* and Katy Kozhimannil recently added to this growing body of literature by comparing the care delivered to patients by NPs versus physicians in the same practices, looking at records for over 29 million patients at more than 3,100 primary care practices across the country.
Among the key findings was that NPs and physicians overlapped on 92% of services delivered. The patient populations and intensity of services delivered were different, however. NPs saw healthier, younger and more non-white patients. While they took fewer appointments in a day, NPs spent a longer time with patients and were more likely to see patients the same day or after hours compared to physicians. Physicians took more appointments and saw sicker and more complex patients, but — perhaps not surprisingly — they spent less time with patients and ordered more services including imaging and prescriptions. The patterns were similar across states allowing for independent practice of NPs versus more restrictive states, although states with more restrictions had more pronounced differences.
An important takeaway is that physicians saw more complex patients, which may be commensurate with their experience, and thus NPs should not necessarily be seen as competition but rather as complements to their practice. With the introduction of telehealth, I am curious whether these patterns of care will hold.

Primary care practices face an uncertain future due to COVID, which may disproportionately affect access to care for underserved populations. As states move beyond professional turf battles, I hope we move toward investments to strengthen team- and patient-oriented primary care.

*Katherine Hempstead works for the Robert Wood Johnson Foundation, one of Tradeoffs’ financial supporters.

Bianca Frogner is an associate professor in the Department of Family Medicine in the School of Medicine at the University of Washington and the director of the UW Center for Health Workforce Studies. She’s a health economist whose recent research focuses on the health care workforce.

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