The Role of State Practice Authority and Educational Infrastructure in Nurse Practitioner Dispersion Patterns

• In Event: Implications of Scope of Practice Reform for Advanced Practice Registered Nurses

Abstract

The geographic distribution of healthcare providers is critical for addressing access disparities. Using nurse practitioners to their fullest capabilities is one way to increase the supply of providers and through that: access to care. The AMA argues that both physicians and NPs tend to cluster in urban areas which is true. However, NPs are more likely to move to less densely populated or underserved regions. Nurse practitioners (NPs) often face barriers to employment in the cities where they graduate. We analyze the conditions in which this occurs. This dispersion is influenced by factors including state regulatory environments and the density of NP training programs. In particular, state full practice authority, which grants NPs autonomy in diagnosing, prescribing, and treating patients, encourage or even push NPs to disperse for employment opportunities.

Using data from Physician Compare and the Area Health Resource File (AHRF), we analyze the effects of full practice authority and NP school density on dispersion patterns for newly graduating NPs. Leveraging a combination of linear and nonlinear models, we examine NP employment trends across urban, suburban, and rural areas. Our preliminary results indicate that state-level full practice authority and higher NP school density are both associated with increased dispersion of NPs into rural and underserved areas. This relationship appears to be mediated by improved job matching opportunities in states with full practice authority, which reduce the necessity for NPs to migrate far from their training locations.

These findings provide insights into the policy levers that shape workforce distribution in the healthcare sector. By facilitating local employment for new NPs, full practice authority and robust educational infrastructure could play a vital role in addressing provider shortages in underserved regions. Future work will explore whether dispersion patterns differ by practice setting or healthcare system affiliation, further illuminating the mechanisms driving these trends.

Author

• David Mitchell, Baltimore City Public Schools
  Presenting Author