January 30, 2023

Nurse Practitioner FPA Reduces Health Disparities in Underserved Communities, Study Finds

Nurse Practitioner FPA Reduces Health Disparities in Underserved Communities, Study Finds

A ground-breaking study from West Virginia University (WVU) has revealed the secret to reducing health disparities in underserved and minority communities: full practice authority (FPA) for nurse practitioners (NPs). The research indicates that those with diverse backgrounds can provide an unparalleled quality of patient care when they share a cultural understanding with patients. 

NPs are increasingly sought-after professionals because they are considered one of the most trustworthy healthcare providers. According to the U.S. Bureau of Labor Statistics, this field is expected to grow faster than any other over the next decade – so it looks like demand for their expertise won't be slowing down any time soon. Their ability to provide high-quality healthcare as well as push boundaries in diagnosis and research is a true testament to their skillset and dedication within medicine.

Alicia Plemmons, John Chambers College of Business and Economics assistant professor and coordinator of Scope of Practice Research at the Knee Center for Study of Occupational Regulation, uncovered evidence that Black and Asian NPs serve more Black Medicare beneficiaries once granted FPA. This represents a positive finding that incurs no additional costs.

Plemmons, along with colleague Edward Timmons, a service associate professor and director of the Knee Center, recently published their findings in the journal Policy, Politics & Nursing Practice. Their findings indicate that states with FPA have a more diverse NP workforce reflective of the state's demographics. As a result of this discovery, researchers argue that all communities can benefit equally from strategic healthcare recruitment efforts.

Additionally, the study identified a complex web of healthcare issues on the horizon. For example, the United States suffers from a shortage of primary care physicians, particularly among vulnerable communities. 

Meanwhile, patients face limited choices when trying to find culturally competent care. At the same time, the debate rages over allowing NPs expanded practice authority that could potentially resolve this issue for millions.

Overregulation of Highly Qualified Nurses Harms Patients, Study Finds

NPs are at the pinnacle of nursing training. When given the freedom of FPA, they can be primary care providers who use their extensive skills without paying for costly collaboration contracts with physicians. 

Generally, monthly collaboration contract costs range from $75 to close to $4,000. So, rather than shelling out hundreds or even thousands each month as part of these agreements, NPs can make full use of their qualifications without having to "pay to play."

Despite their ability to meet with patients nationwide, NPs face restrictions and oversight that differ depending on the state. These limitations can range from requiring physician supervision or collaboration agreements to being barred from making specialist referrals and ordering imaging services. Plemmons further explained that "the most contentious restriction is prescribing medication," a topic that continues to ignite intense debate. 

Taking A Closer Look At The Study's Results

Plemmons and Timmons conducted nationwide research to explore the influence of FPA on racial and ethnic diversity in the NP workforce. They compared NPs' backgrounds with those of their patients and state populations. Remarkably, they discovered that states allowing FPA had a far higher concentration of NPs from diverse cultural heritages like Black, Asian, or Hispanic communities than non-FPA states, demonstrating its impact. 

Across the board, healthcare representation varied by community. However, Black NPs in states with FPA served an impressive 2.8% more African-American Medicare beneficiaries than their non-FPA counterparts.

The Importance of This Study for The Future of NPs

Interestingly, this study echoes past research in confirming that patients of color are more likely to engage with their healthcare when they have a provider who connects on a cultural level. 

When there is an understanding on both sides about unique cultural values, these outcomes can be achieved:

  • Increased attendance for annual check-ups

  • Better communication about health concerns

  • Improved compliance with treatment plans

Researchers agree these are all critical components to helping close disparity gaps among minority populations.

Additionally, experts warn that America faces a looming crisis - a growing physician shortage that will only continue to worsen in the coming years, particularly in minority communities. According to The Association of American Medical Colleges, experts predict that the industry may experience shortages ranging from 54,000 to 139,000 physicians by 2033. 

The shortage threatens the area of primary care particularly hard, as most physicians tend to train in higher-earning specialties rather than take up more rewarding yet less lucrative areas such as primary care.

And as the physician workforce dwindles, NPs are rising to meet an ever-growing need for primary care and are in greater demand than ever. Dr. Plemmons gave further insight into her optimism, noting that nearly 82% of NPs will focus on primary care with a steady per capita supply, offering hope to those who seek it most.

Practice Authority Grows

With the onset of COVID-19 in 2020, 26 states across the US – including Washington D.C.– temporarily waived FPA restrictions to better address growing health needs during the pandemic. 

Nevertheless, despite many waivers still being in effect today, in certain areas, NPs cannot provide care to communities where physicians refuse to practice due to policies that demand close physician supervision to deliver care and prescribe medications. In turn, this limits access for those most vulnerable. 

Notably, the authors of the study highlighted West Virginia's unique approach to tackling the disproportionate access to health services in rural and underserved communities. 

After three years of physician oversight, NPs in West Virginia can enjoy the same responsibilities and prescription authority as regular physicians. However, the power to prescribe Schedule II drugs remains off-limits. 

This state's policy is one of the most advanced in its South Census region, although it still falls short of national standards as a whole.

From the data, it's clear that NPs with FPA could significantly reduce health disparities faced by minority populations. The looming primary care physician shortage, particularly in underserved communities, calls for decisive action on the part of lawmakers. 

A compassionate bedside manner and ample time spent with each patient are all hallmarks of a nurse practitioner's style of care–qualities that many healthcare leaders consider vital for achieving equity in healthcare. 

Though there is still much work left to do, these latest findings confirm the positive effects of NPs who can practice independently. By doing so, NPs can ensure that the healthcare safety net is stronger than ever.