The Impact of Nurse Practitioner Education Programs on Local Labor Markets and Population Health

• In Event: Provider Supply and Assessment

Abstract

The number of nurse practitioners (NPs) working in the United States has more than doubled in the past decade. Meanwhile, many states have adopted policies allowing nurse practitioners to diagnose and treat patients without physician oversight, with the goal of reducing physician shortages in underserved areas. However, critics of these policies argue that nurse practitioners may provide a lower quality of care due to reduced training requirements when compared to traditional physicians. This paper explores the impact of expanding the nurse practitioner workforce on local healthcare labor markets, healthcare utilization, and population health.
I use the introduction of over 160 new nurse practitioner education programs between 2011 and 2022 in a staggered difference-in-differences design to estimate the impact of these programs on local labor markets and population health. While previous literature has primarily focused on the policy implications of expanding scope of practice at the state level, I investigate the impact of expanding the nurse practitioner workforce in states with both full and restricted scope of practice.
I find that the number of locally practicing NPs increases significantly following the introduction of a new NP education program to an area, as does the probability that a patients seekign care locally have visited an NP in a given year. I find little evidence that these NPs crowd out substitutable physicians such as general practitioners, family physicians, and OBGYNs. Similarly, I find no effect on wages of these physicians.
In ongoing analysis, I use claims data covering Medicaid and Medicare recipients as well as commercially insured individuals to examine whether these programs lead to an increase in utilization among patients seeking care in treated areas, or if patients are merely substituting nurse practitioners for traditional physicians. Finally, using National Vital Statistics mortality data, I find that these programs lead to a decrease in maternal mortality, with no impact on all cause mortality or influenza mortality.

Author

• Jacqueline Michelle Blair, Cornell University
  Presenting Author