No doubt you’ve heard of nurse practitioners (NPs), but what exactly do they do? Is their role like regular nurses? Are they more like doctors? What part do they play in the healthcare picture?
According to the Bureau of Labor Statistics, NPs perform many of the same tasks as physicians. NPs focus on diagnosing and treating illnesses and ordering, performing, or interpreting diagnostic tests such as lab work and x-rays. They work in hospitals, physicians’ offices, and other healthcare facilities and in both primary and urgent care.
However, NPs face limitations that restrict their ability to provide care and expand healthcare access. Despite being highly trained, in many states NPs are required to work under physician supervision, limiting their autonomy. Scope-of-practice laws vary, with some states preventing NPs from diagnosing conditions, prescribing medications, or opening independent clinics. These restrictions create bottlenecks, particularly in underserved areas, and reduce patient access to timely care. Granting autonomy to NPs removes these barriers, helps the healthcare industry evolve, and makes healthcare more accessible for patients who may need care the most.
Barriers for Nurse Practitioners to Overcome
Scope of Practice Laws
According to the American Association of Nurse Practitioners, NPs practice in nearly every healthcare setting, including clinics, hospitals, emergency rooms, urgent care offices, private physician practices, nursing homes, schools, colleges, and more.
However, scope-of-practice laws vary in each state and restrict what tasks NPs are able to provide when caring for patients. These rules often negatively impact patients in rural or disadvantaged areas because specific tasks can only be taken on by a doctor.
Restrictions on NPs’ practice vary by state and are classified into three categories: full practice, reduced practice, and restricted practice. In states that allow NPs full practice, NPs can perform many of the same tasks as physicians. Some states give NPs “reduced practice” and require them to have a collaborative agreement with a physician. And finally, in other restricted practice states NPs are not allowed to practice independently. If you’re curious about the laws in your state, check out this detailed chart.
Prescribing Barriers
In many states, NPs are required to have a supervisory agreement with a physician to prescribe medications, including routine treatments. Some states restrict their ability to prescribe controlled substances, such as opioids, or require additional certifications and oversight. Furthermore, variations in state laws create inconsistencies, complicating telehealth practices and cross-state care. Administrative burdens, such as prior authorizations, also delay patient access to medications. These restrictions particularly impact care in underserved areas, where physician oversight may be scarce, reducing the NP’s ability to manage patient needs independently.
According to the Mercatus Center at George Mason University, patient outcomes are equivalent for NPs and doctors — but NPs come with a lower price. If all states allowed NPs to practice autonomously without physician oversight, including dropping prescribing barriers, one estimate presented in Health Affairs puts the potential cost savings at $810 million.
Procedures that are Physician-Only
Certain medical procedures and responsibilities are typically restricted to physicians due to legal, regulatory, or scope-of-practice limitations. Physicians generally perform more complex surgical procedures such as major surgeries, neurosurgeries, or orthopedic surgeries. NPs are also limited when it comes to specialized diagnostics; only physicians are allowed to interpret imaging studies, advanced genetic testing, and specialized pathology reports. Additionally, NPs aren’t allowed to manage patients with chronic conditions that may require advanced-level decisions, such as those with severe illnesses, high-risk pregnancies, and more.
Restrictions on Therapy
NPs can order or provide a range of therapeutic services, but once again they face limitations. In most — but not all — states NPs can assess a patient’s needs and order physical therapy.
When it comes to mental health, psychiatric-mental health nurse practitioner programs are a growing specialty, providing training related to mental health assessments, medications, neuroscience for mental health, ethics, and more. To practice, in most states psychiatric-mental health NPs must pass the Psychiatric-Mental Health Nurse Practitioner Certification, which is a four-hour, 200-question test.
The varied rules for NPs in providing therapy plays a role with insurance billing, which can affect an NP’s bottom line. Some insurance providers limit reimbursement or coverage for therapy sessions if conducted by NPs instead of a licensed mental health counselor or therapist.
Administrative and Licensure Barriers
Administrative and licensure barriers for NPs differ significantly between each state. Nurse practitioners must be licensed in each state where they practice; however, differences in regulations often create delays in obtaining multi-state licensure.
Limiting NP autonomy also adds administrative burdens to healthcare practices, resulting in additional fees or creating delays in care delivery when physicians are unavailable. This impacts the NP’s effectiveness and the cost of patient care.
Unequal Reimbursement
As mentioned above, some insurance providers limit reimbursement or coverage for care given by NPs. Hospitals and insurers often impose lengthy credentialing processes, delaying NPs’ ability to bill for services. Additionally, some insurers reimburse NPs at lower rates than physicians for identical services, discouraging independent practice.
Little to No Physician Oversight
While in many cases NPs are required to have a collaborative agreement with physicians, NPs often experience little to no true physician oversight. These rigid regulations and restrictions are in place to ensure patients receive care from both NPs and physicians, but often only restrict the scope of work and tasks NPs can provide as part of quality care.
Physician Signature Requirements
NPs often face physician signature requirements, which limit their ability to practice independently and can create delays in care. These requirements vary by state. For example, most states require a physician’s signature or collaborative agreement for NPs to prescribe controlled substances, such as opioids. Additionally, even if an NP is primarily managing a patient’s care, only physicians can sign off on disability determinations and workers’ compensation claims. Physicians’ signatures are usually required for admittance or discharge from hospitals and nursing homes as well. That said, 16 states recognize NP signatures on a broader range of forms, as long as the treatment matches the scope of practice.
Weakened Cooperation between Colleagues
Physician oversight requirements create friction and weaken collaboration between NPs and their colleagues. While NPs can usually perform the same tasks as physicians, these regulations preserve a healthcare hierarchy and discourage open communication and equality among healthcare teams. Additionally, because physicians’ signatures and oversight are often required, prescriptions, diagnostic tests, and treatment plans can be delayed. The need for physician supervision can cause an administrative burden with extra paperwork.
Issues with Telehealth
NPs face multiple challenges when delivering care through telehealth. Some telehealth appointments require a more in-depth physical exam, resulting in the patient needing to make an in-person appointment with a physician. Additionally, if the NP can’t prescribe medication then they can’t completely care for the patient. In some cases, NPs may not get reimbursed for telehealth services. Bottom line, when it comes to telehealth all medical practitioners need to know the treatment and prescribing requirements of their home state and telemedicine states to ensure there are no differences in standards of care.
The Benefits of Nurse Practitioner Autonomy
Granting autonomy to NPs removes barriers to their practice and has been shown to improve healthcare access, especially for patients in underserved and rural areas. NPs can provide high-quality, patient-centered care comparable to physicians and, in some cases, with greater patient satisfaction. By granting NPs full practice autonomy, patients could experience greater healthcare access and improved care, NPs could provide relief for physician burnout and experience higher job satisfaction and accountability, and healthcare systems can realize cost-efficiency.
Greater Healthcare Access
Granting NPs full practice autonomy significantly expands healthcare access, particularly in underserved and rural areas. Without the need for physician oversight, NPs can open independent clinics, provide care in remote locations, and offer a wider range of services, including diagnosing, prescribing medications, and managing chronic conditions. This autonomy reduces bottlenecks in care, allowing patients to receive timely treatment without waiting for physician availability. Additionally, NPs fill gaps in primary care created by physician shortages, offering preventive care, mental health services, and chronic disease management.
Improved Patient Care
Allowing NPs to be fully autonomous leads to improved patient care by enabling them to work more efficiently and independently. NPs can provide comprehensive services, including diagnosing, prescribing, and managing treatment plans, without delays from physician oversight. This autonomy fosters continuity of care, as patients can build long-term relationships with NPs, improving trust and health outcomes. According to the Mercatus Center, one study found that patients were more satisfied with consultations with NPs than with doctors.
Relief for Physician Burnout
According to the Agency for Healthcare Research and Quality, physicians get burned out due to the nature of the demanding pace, time pressures, and emotional intensity of the healthcare environment. Burnout is a long-term stress reaction marked by emotional exhaustion, depersonalization, and a lack of personal accomplishment. During COVID, some studies estimated as many as 63% of physicians experienced burnout, which can lead to a decreased quality of care and safety for patients. Post-COVID, physician burnout rates have improved but still present a potential danger to patient care.
The American Medical Association (AMA) estimates that, while burnout results from a variety of factors, the physician burnout epidemic can be associated with system inefficiencies, administrative burdens, and increased regulation and barriers to efficient practice. In a 2024 study published by AMA, more than one-quarter of physician respondents said they didn’t have enough support staff. Additionally, almost 13% said that too many administrative tasks led to burnout.
As such, granting NPs full practice autonomy can significantly alleviate physician burnout by redistributing patient care responsibilities. With NPs able to practice independently, they can handle routine cases, chronic disease management, and preventive care, allowing physicians to focus on more complex cases. This collaborative approach not only reduces the workload for physicians but also minimizes the administrative burden associated with overseeing NPs.
Job Satisfaction
Granting NPs full practice autonomy would significantly boost job satisfaction by allowing them to make clinical decisions based on their own expertise, manage patient care fully, and experience a greater sense of ownership and control over their practice.
With current barriers, including scope of practice laws, administrative and licensure barriers, unequal reimbursement, and physician signature requirements, more NPs have lost satisfaction in their careers because they aren’t able to fully assist and care for patients. With the ability to make independent clinical decisions, NPs can tailor care to meet the specific needs of their patients without waiting for physician approval. This empowerment fosters a sense of ownership and accountability in their practice, enhancing their professional identity.
Additionally, having the autonomy to establish long-term patient relationships allows NPs to engage in comprehensive care, promoting a fulfilling practice experience. By removing barriers, NPs can experience reduced administrative burdens, potentially earn more, and advance their careers, resulting in overall increased job satisfaction and reduced feelings of frustration or burnout associated with restrictive oversight or the day-to-day challenges that go with the healthcare field.
Cost-Efficiency
Allowing NPs full practice autonomy enhances cost-efficiency for patients in several ways. First, NPs can provide a broad range of services, including primary care, preventive services, and chronic disease management, often at lower costs than physicians. This leads to reduced out-of-pocket expenses for patients, as NPs typically charge lower fees for similar services. According to the Mercatus Center, limited the ability to write prescriptions to doctors only raises costs by more than 11%, equating to approximately $109 in extra expenses for each Medicaid beneficiary.
With the ability to practice independently, NPs help reduce healthcare system bottlenecks. By managing routine care without requiring physician oversight, NPs decrease wait times for appointments and expedite access to treatment. This timely care prevents complications and costly emergency interventions, saving patients money in the long run — not to mention saving lives.
In a study published by the Journal of Nursing Regulation, states with full scope of practice for NPs had 17% lower outpatient costs. States with restricted scope of practice had 11.6% higher outpatient costs.
In the overall look of cost-efficiency, physician burnout costs the United States healthcare system $4.6 billion a year due to physician turnover and work-hour reductions. Empowering NPs with full practice autonomy would be more cost effective for both patients and the healthcare system.
