Supply and Demand

College of Health Professions Assistant Professor Andréa Sonenberg discusses how the anticipated increases in the number of insured will affect the already short supply of primary care providers.

“We’re going to see about 32 million newly insured people on our rosters, most of which will be on the Medicaid rosters,” says Andréa Sonenberg, DNSc, WHNP, CNM, an Assistant Professor in the College of Health Professions. “The potential problem being projected is that we won’t have enough primary care providers to service this newly insured population.”

With the Supreme Court’s decision on the Patient Protection and Affordable Care Act (PPACA) taking place this past June, and with the outcome of this year’s Presidential Election, it is expected that the PPACA will progress to full implementation over the course of the next two years. In an effort to seek out ways to improve access to care for the newly insured, Sonenberg and Dyson Assistant Professor of Public Administration Hilary Knepper, PhD, teamed up with Joyce Pulcini, PhD, PNP-BC, FAAN, FAANP, of George Washington University to examine the role of regulatory policies on the practice of nurse practitioners and the health outcomes of would-be patients throughout the United States.

“Our premise is that regulatory policy impacts the ability of nurse practitioners to practice to the full extent of their education and scope of training,” asserts Sonenberg, who goes on to say that the Institute of Medicine recommends the expansion of the scopes of practice for nurse practitioners, who studies have shown to have clinical outcomes that are at least as good as physicians, and who’s patient satisfaction rates are oftentimes significantly higher than physicians.

“Nurse practitioners are a high-quality, cost-effective solution to the primary care shortage,” Sonenberg says, “Not to mention that they’re highly sought after by patients.”

Currently, many of the regulations governing scope of practice within the country, which vary from state to state, are very restrictive. The restrictions typically come in three areas: legislative, which regulatory body decides what the scope of practice for nurse practitioners can be; reimbursement policy, the percentage of the service fee Medicaid or a private insurer is willing to pay a nurse practitioner for providing the same service as a physician; and finally prescriptive authority, which gives nurse practitioners the right to prescribe medications independently of physician supervision.

“We look at how many nurse practitioners practice in a particular state, what percent of the services under Medicaid are delivered by nurse practitioners in that state, the population health outcomes in the state, and whether or not there is any correlation of those variables to the regulatory policies within the state,” she says.

States with more stringent restrictions on scope of practice for nurse practitioners may be less likely to attract nurse practitioners, which potentially impacts the patient population’s access to care within the state. If nurse practitioners are only earning 85 cents to the dollar as compared to a physician delivering the same service, or if a nurse practitioner is able to diagnose a patient’s health issue but must send the patient to a physician to receive a prescription for medication, access to care becomes even more strained.

“I think it’s so important to do this work collaboratively and intercollegially,” says Sonenberg. “I think it expands our perspectives and viewpoints as scholars. For example, working with our colleague in Public Administration has offered a different perspective than solely the health care outcome perspective. And working with a researcher from George Washington University gives us a new geographical outlook, which is especially important when looking at policies that vary depending upon location.”