What does the U.S. landscape for nurse practitioner practices look like? (infographic)

Copy of AANP state policy map

There’s no doubt that nurse practitioners are getting a higher profile. Many states, especially where primary care physicians are few in number, have let nurse practitioners set up independent practices without a hospital or physician looking over their shoulder. But in states reviewing this legislation, the issue has spurred debate between those who believe physicians should ultimately be responsible for patient care and those who see nurse practitioners as the best option to address the primary care physician shortage.

The American Association of Nurse Practitioners’ map illustrates the policy differences from state to state. Western states appear to be the most autonomy-friendly areas while the southeastern states are the most restrictive.

A Wall Street Journal article highlighting the issue shows that 17 states currently allow nurse practitioners the autonomy to set up their own practices and treat patients. But in five states, including Pennsylvania, California, Michigan and Massachusetts, a showdown is taking place between nurse practitioner supporters, physician groups and others as politicians consider legislation granting nurse practitioners full autonomy. New Jersey would grant independence to nurse practitioners after they have spent two years working with a physician or an advanced practice nurse, according to the article.

The increase in nurse practitioner numbers began well before the passage of the Affordable Care Act. But new care models outlined in the Affordable Care Act such as patient-centered medical homes and accountable care organizations rely on nurse practitioners and physician assistants to staff them. The growth of drug store health clinics staffed by nurse practitioners has accelerated the demand.

Although California’s senate approved a bill granting autonomy to nurse practitioners to alleviate the problem facing some parts of its 58 counties that lack a sufficient number of primary care physicians to care for the population. The California Medical Association has lobbied against the bill warning that it will reduce the quality of care. As a compromise, a committee proposed a change to the bill that would require nurse practitioners to do 6,000 of supervised work as part of a path to autonomy.

The question of nurse practitioner independence has been such a contentious issue that Nevada wrangled with it for six years before Republican Gov. Brian Sandoval signed a law permitting it in June. There, nurse practitioners are required to have at least two years’ experience before they can set up their own practice. Of states with the least physicians per capita, Nevada is ranked fifth.