DiversityNursing Blog

The healthcare landscape is evolving rapidly, and at the forefront of this transformation is the rise of Nurse Practitioners (NPs). With a growing shortage of physicians, an aging population, and increased demand for accessible care, NPs have become an integral part of the healthcare system. But with this rise, a question often comes up: Are Nurse Practitioners replacing Doctors? Let’s take a closer look at the role of NPs, their impact on healthcare, and whether they are a threat to the traditional role of Physicians.

Who Are Nurse Practitioners?

Nurse Practitioners are Advanced Practice Registered Nurses (APRNs) who have completed additional education and training beyond their Registered Nurse (RN) licensure. Most NPs hold a master’s or doctoral degree and are trained to diagnose illnesses, prescribe medications, and provide treatment. They often specialize in areas such as family medicine, pediatrics, women’s health, or geriatrics.

What sets NPs apart from RNs is their expanded scope of practice, which allows them to deliver primary, acute, and specialty care independently or in collaboration with a Physician, depending on the state in which they practice.

The Impact of NPs on Healthcare

Increased Access to Care One of the biggest impacts of the rise of Nurse Practitioners is improved access to healthcare, especially in underserved or rural areas. NPs are often more likely to work in these regions, helping to fill gaps in care where Physicians may be scarce. As the shortage of Doctors continues, particularly in primary care, Nurse Practitioners provide a much-needed solution, offering care to patients who might otherwise have difficulty accessing services.

Cost-Effective Care Nurse Practitioners provide high-quality care at a lower cost than Physicians, helping to reduce healthcare expenses for both patients and healthcare systems. Studies have shown, the care provided by NPs is just as effective as that delivered by Doctors for a wide range of primary and chronic conditions. With healthcare costs skyrocketing, Nurse Practitioners play a crucial role in containing costs while maintaining patient satisfaction.

Patient-Centered Approach One of the hallmarks of NP practice is a focus on patient-centered care. NPs are known for spending more time with patients, taking a holistic approach to health, and emphasizing education and prevention. This personalized care often results in better patient outcomes and higher satisfaction rates, making NPs a popular choice for many patients.

Alleviating Physician Burnout As Physician burnout continues to be a major concern in healthcare, Nurse Practitioners help alleviate the pressure by sharing the patient load. NPs can handle many of the same responsibilities as Doctors in primary and specialty care settings, allowing Physicians to focus on more complex cases. This collaborative approach benefits both healthcare providers and patients, as it leads to better work-life balance for Doctors and more comprehensive care for patients.

Are Nurse Practitioners Replacing Doctors?

While Nurse Practitioners are playing a larger role in healthcare, they are not "replacing" Doctors. Instead, they are filling a critical need, especially in primary care. The role of a Doctor remains essential, particularly in specialized fields like surgery, oncology, and complex diagnostics, where advanced medical training is required.

The relationship between NPs and Physicians is increasingly seen as complementary rather than competitive. In many settings, NPs and Doctors work together to provide high-quality care, leveraging each other’s strengths. Collaborative care models, where Physicians and NPs work in tandem, are becoming more common, leading to better patient outcomes.

State Regulations and Scope of Practice

One key factor in the rise of Nurse Practitioners is the expansion of their scope of practice in many states. Currently, 27 states and Washington, D.C., allow full practice authority for NPs, meaning they can diagnose, treat, and prescribe medications without Physician oversight. Other states have more restrictive regulations, requiring some level of Physician supervision or collaboration.

The trend toward granting NPs full practice authority is likely to continue as healthcare systems seek more flexible solutions to meet patient demand. This shift doesn't diminish the importance of Physicians but instead broadens the range of options for patients to receive timely, effective care.

The Future of Healthcare: A Team Approach

The rise of Nurse Practitioners is a positive development for healthcare. With their ability to provide quality, cost-effective care, NPs are helping to bridge the gaps in access and affordability. However, the future of healthcare isn’t about choosing between Doctors and NPs—it’s about collaboration. By working together, Doctors and Nurse Practitioners can create a more efficient, patient-centered healthcare system that meets the needs of a diverse and aging population.

In conclusion, while Nurse Practitioners are stepping into roles that were once dominated by Physicians, they are not replacing Doctors. Instead, they are enhancing the healthcare system by providing accessible, personalized care, helping to alleviate Physician shortages, and improving outcomes for patients. The future of healthcare lies in teamwork, with NPs and Physicians working side by side to deliver the best care possible.

The American Association of Nurse Practitioners (AANP) reported more than 355,000 Nurse Practitioners (NPs) are licensed to practice in the U.S. This is up 9% from the estimated 325,000 reported in May 2021.

This increase in NPs will help aid the healthcare provider shortages and ease burnout from the COVID-19 pandemic. 

“Nurse Practitioners are answering the call to provide vital health care services to all Americans,” said AANP President, April N. Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN. “With the challenges of the pandemic and the demand for more accessible and equitable care, NPs continue to enhance health care delivery across all settings. Today’s Nurse Practitioner count indicates that demand for these highly-qualified clinicians continues to be on the rise — and for good reason.”

Nurse Practitioner holds the first spot on U.S. News and World Report's 2022 Best Health Care Jobs list and second on the 2022 100 Best Jobs list. 

Kapu said, “These rankings highlight what we have known for some time: the NP role is not just a job, it’s a calling for more than 325,000 NPs who are working tirelessly on the front lines of health care, from hospitals to primary care clinics, in patients’ homes and via telehealth. NPs are highly trained and committed health care providers improving the health of their patients and communities. As we enter the third year of the COVID-19 pandemic, America’s NPs will continue delivering high-quality care in every health care setting and expanding access to care in vulnerable and underserved communities. Their dedication makes me proud to be an NP.”

As of May 2021, the Bureau of Labor Statistics (BLS) lists these 5 states as having the highest employment levels for Nurse Practitioners:

• California
• New York
• Texas
• Florida
• Tennessee 

Nurse Practitioners in the U.S. make an average of $118,040 annually, according to the BLS. 

Currently, more than 25 states allow NPs to practice independently. This means they can open their own clinics and treat their own patients without needing a Physician to oversee the practice.

A career as an NP is very rewarding and allows more freedom and flexibility than many other types of Nursing positions. 

Research shows there has been a steady decrease of Physicians across the United States, especially primary care Physicians.

The data published by the Association of American Medical Colleges (AAMC) projects shortfalls in primary care Physicians of between 21,400 and 55,200 by 2033.

The U.S. Department of Health and Human Services (HHS) reports, 80 million Americans lack adequate access to primary care, primarily in rural areas.

Nurse Practitioners (NPs) have the ability to help fill this void.

The number of NPs is at a record high and the demand is growing. According to the American Association of Nurse Practitioners (AANP), in 2019, there were more than 290,000 licensed NPs in the United States.

The Bureau of Labor Statistics (BLS) reports, the overall employment of Nurse Practitioners is projected to grow 45% from 2019 to 2029, much faster than the average for all occupations.

AANP data also shows 89.7% of Nurse Practitioners are prepared to practice in primary care with specialties in family (65.4%), adult (12.6%), pediatrics (3.7%), women’s health (2.8%), and gerontology (1.7%), among other specialties.

However, many states still impose restrictions on the care NPs can provide.

Some states require NPs to be supervised by a Physician and other states restrict NPs from practicing a certain distance from their supervising Physicians.

NPs can prescribe medications and controlled substances, but a few states require they do so in collaboration with a supervising Physician. Some states also impose probationary periods before NPs are allowed to prescribe medications.

Nurse Practitioners should be able to work to the full potential of their education and training.

Patients trust the care they receive from Nurses. Evidence supports the notion that NPs provide care that is comparable to Physicians in terms of quality, utilization, and satisfaction.

AANP President Sophia Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP said, “An estimated 1.06 billion patient visits were made to NPs in 2018, improving the health of our nation and increasing the growing number of patients who say, ‘We Choose NPs.’”

As of March 2021, the average Nurse Practitioner salary is $111,478. Pay varies depending on education, certifications, the state you work in, additional skills, and the number of years in the field.

Nurse Practitioners are a critical resource for improving population health and reducing health disparities.

Physician shortage concerns has influenced the use of more Nurse Practitioners to provide primary care and fill gaps in rural areas.

According to a new Health Affairs study, the number of Nurse Practitioners grew 109% from about 91,000 to 190,000 from 2010 to 2017.

Even though Nurse Practitioners have filled gaps in the delivery of healthcare, it is creating problems for hospitals. 

The Registered Nurse workforce has been reduced by up to 80,000 RNs nationwide. Also more than one million baby-boom RNs will be retiring soon.

The study says, the growth in NPs was caused by the expansion of education programs that have attracted Millennial Nurses. The number of programs to educate NPs grew from 356 in 2010 to 467 in 2017. These programs now graduate nearly as many new NPs as medical schools do Physicians each year.

Data from the Census Bureau’s American Community Survey for the period 2010–2017 was used in the study and researchers found the growth of NPs occurred in every region of the country, but was particularly rapid in the east south-central region of the country, which includes Alabama, Kentucky, Mississippi and Tennessee.

Also it is projected there will be two NPs for every five Physicians by 2030, compared to less than one NP per five Physicians in 2016. 

The number of Physician Assistants is also one of the fastest-growing in healthcare. According to a report from the National Commission on Certification of Physician Assistants, the number of certified PAs grew over 6% in 2018 and the average salary increased by more than 12% in a four-year span.

Authors of the Health Affairs study said, "As NPs continue to expand their profile in healthcare organizations and achieve greater prominence within the healthcare workforce, the potential loss of RNs to the NP workforce is likely to continue to cause employment ripples, particularly in acute care settings. Thus, even in an era of strong RN workforce growth fueled by Millennials in particular, hospitals must innovate and test creative solutions to contend with tight or fluctuating RN staffing — as they have during past disruptions in their RN labor supply."

The U.S. population is growing increasingly diverse. By 2020, the U.S. Census Bureau projects less than 50% of the children in the U.S. will be non-Hispanic and Caucasian. With demographics shifting, health care professionals trained in cultural competence will meet the needs of community health more effectively.  Nurse practitioners earning their Master of Science in Nursing can gain exposure to cultural competency in nursing practice. Trained NPs can help reduce disparities minorities experience, such as lower quality care, through improved awareness.

Culture’s Influence on Health Beliefs and Perception

Culture includes the knowledge, beliefs, and behavior of different groups of people. Elements of culture influence health knowledge and beliefs, as well as behaviors and measures that are taken to promote health. Understanding and respecting different cultures is a critical aspect of providing holistic, effective care.

Nurse practitioners must be culturally competent to be able to effectively listen to their patients’ health concerns, treat their health conditions in ways that are acceptable to the patient, and communicate in ways that are responsive and respectful of the patient’s culture. Here are a few ways that culture and ethnicity influence the care patients receive:

Body Language

Cultural norms highly influence body language. One example is the degree of eye contact with which individuals are comfortable varies. Some cultures express respect by not making eye contact, which can lead health care providers to view the patient as withdrawn, and suspect depression or anxiety if not informed of this difference. Eye contact may also be viewed in some cultures as flirtatious, or even disrespectful.

Experience of Pain and Illness

Different cultures have different ways of coping with illness and pain. These differences influence how, when, and whether individuals seek care. Cultures with an acceptance of pain as part of life may not report their pain to health care providers, and may not consider it a health problem.

Emotional responses to pain are also influenced by culture. Cultures that value stoicism may warrant less outward expression of pain, leading uninformed providers to believe that the individual isn’t suffering. Other cultures expect individuals in pain to react emotionally. Nurse practitioners must be mindful of differences in how cultures view, express and accept pain.

Decision-Making

Decision-making regarding health is also approached differently among ethnic groups. Some cultures value making health decisions as a family, or the individual receiving care will make the decision themselves, or the patient may appoint another family member to make decisions regarding their care. Nurse practitioners must be mindful that the patient may want to discuss options with their loved ones before accepting or declining a health care treatment plan.

Linguistic Barriers

Identifying linguistic barriers is another important aspect of cultural competence. Individuals may be able to communicate basic health needs to the provider, but have difficulty understanding the terminology used in the practitioner's response. NPs must be mindful of this, and also that some patients are not comfortable indicating that they don’t understand. Linguistic barriers can lead to the provider either missing or misinterpreting some of the nuances of the patient’s symptoms.

One way to help identify a linguistic or learning style barrier is through using the teach-back method. After explaining a health condition or treatment to the patient, the nurse practitioner then asks the patient to return the teaching. If they’re unable to do so or demonstrate some difficulty, interpretation services or a different teaching style, such as the use of audio or visual aids, may be necessary. Interpretation services should always be made available to those who speak English as a second language. Interpreters can also help providers better understand cultural differences.

Treatment Tailored to the Patient

Receptivity to cultural differences also influences treatment accepted by the patient. If a provider is not sensitive to or respectful of cultural differences, patients from diverse backgrounds may experience confusion or frustration. This may lead to them initially accepting treatment, but once home they may not follow through because they don’t trust the provider, don’t understand the purpose of the prescribed treatment, or the care plan conflicts with cultural values.

Taking Initiative as a Nurse Practitioner

Improved awareness helps eliminates assumptions made during care and gives voice to patients, so they can adequately express their concerns. Understanding cultural diversity in nursing also helps close the gap in health equity, reducing health disparities affecting minority populations such as higher morbidity rates and lower quality care.

Nurse practitioners are responsible for improving their own cultural competency to ensure that all patients receive effective care. The Agency for Healthcare Research and Quality offers many ideas to improve cultural awareness-one way is by respectfully asking patients about their beliefs in the context of health and treatment.

Nurse practitioners can also benefit from attending courses on cultural diversity in practice, participate in community organizations, and research the norms of different cultural and ethnic groups. Broadening one’s own understanding of culture and how people interact improves the professional ability to make meaningful connections with patients.

References:

Agency for Healthcare Research and Quality. (2015). Consider culture, customs, and beliefs: Tool #10. https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/healthlittoolkit2-tool10.html

National Institute of Health. (N.d.). NIH fact sheets - Health disparities. https://report.nih.gov/nihfactsheets/viewfactsheet.aspx?csid=124

Peacock, S., Patel, S. (2008). Cultural influences on pain. Reviews in Pain: British Pain Society, 1(2), 6-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4589930/.

United States Census Bureau. (2018). Older people projected to outnumber children for first time in U.S. history. https://www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html

Holly Rinehart, RN, BSN, is a registered nurse and writer for the Carson-Newman University blog. She specializes in emergency and perioperative nursing and cherishes the opportunity as a nurse to help serve and comfort those in vulnerable positions. In her free time, she enjoys traveling and telling nurse stories to anyone who will listen.