Why They Might Stay: Nurse Practitioner Careers in Primary Care

• In Event: 315 - Regular Session. Producing Gender at Work

Abstract

With the implementation of the Affordable Health Care Law, the demand for primary care providers has never been greater. However, the supply of primary care physicians has not kept pace with this demand. Increasing the number of nurse practitioners (NPs) has been offered as one solution. However, this policy fix raises a practical question: why should we expect nurse practitioners to behave differently then physicians? Faced with similar career disincentives, why will they choose to stay in lower paying primary care and community based practices? This paper analyzes the career biographies of nurse practitioner students and practicing NPs in order to better understand if and why we can expect NPs to behave differently than physicians. The analysis places these biographies in conversation with physician careers, situating both within a broader system of occupational and social stratification. I find that nurse practitioners and physicians are not simply different professionals at the end of distinct training regimes; they faced different choices and constraints prior to their training, during their training, and in their longer career paths. Moreover, many of these constraints are institutionalized within the professions themselves. Through exploring the ways in which these biographies intersect with specific gendered and classed careers, this paper provides a structural and institutional understanding of NP difference that will better help us to understand not only why physicians are continuing to leave primary care, but also why nurse practitioners just might stay.

Author

• LaTonya Trotter, Vanderbilt University