Researchers from the Department of Health Policy in the GW School of Public Health and Health Services have found that an increased "scope of practice" for advanced practice nurse practitioners is not associated with lower wages for primary care physicians, based on comparisons in states with more liberal and more restrictive policies.

Advanced practice nurse practitioners are registered nurses who have taken additional graduate training to practice a wider range of medical care. In 2010, the Institute of Medicine (IOM) recommended removing scope of practice (SOP) barriers for nurse practitioners, so that they can "practice to the full extent of their education and training." Sixteen states and the District of Columbia have more liberal scope of practice laws that let nurse practitioners diagnose and treat patients without physician supervision or with the signing of a one-time collaboration agreement with a physician or the state board of nursing.

While increased independence for nurse practitioners may help ease primary care shortages in many areas, some primary care physicians have been concerned that competition with independent nurse practitioners might lower their incomes, which are already far below incomes of physician specialists. This study found that there were no significant differences in wages of primary care physicians in states with and without more liberal scope of practice law, based on data from the federal Bureau of Labor Statistics.

"As we plan for the expansion of health care coverage to over thirty million people in 2014, the shortage of primary care providers will be one of the major challenges. As a result, it is important to systematically assess whether there are negative consequences for primary care doctors associated with an expanded role for nurse practitioners. Our study is a first step in that assessment. We found no evidence of negative economic impact on family physicians and internists in States that have already implemented reforms," said lead researcher Patricia Pittman, Ph.D., associate professor in the Department of Health Policy in the GW School of Public Health and Health Services and the School of Nursing.

Jean Johnson, PhD, RN, Dean of the GW School of Nursing adds, "Health reform will require a dramatic increase in the level of primary care services. Well trained nurse practitioners have a critical role to play in meeting the nation's health care needs, both in working alongside and, in some cases, independent of their physician counterparts."