One study that examined the impact of NPs and Physician Assistants (PAs) on medically complex patients with diabetes showed that case-mix-adjusted total care costs were 6–7 percent lower for NP and PA patients than for physician patients, driven by more use of emergency and inpatient services by the latter. The finding validated that the use of NPs and PAs as primary care providers for complex patients with diabetes was associated with less use of acute care services and lower total costs. With a focus on illness prevention, NPs can have a significant impact on decreasing healthcare costs.

Rural residents are older and sicker than their urban counterparts and are at higher risk of death from conditions like stroke, heart disease and cancer. These residents also lack ease of access to medical care. In rural areas the patient-to- primary care physician ratio is 39.8 physicians per 100,000 people, compared to 53.3 physicians per 100,000 in urban areas. In addition, a new report from the Center for Healthcare Quality and Payment Reform indicates that more than 29 percent of rural hospitals nationwide are at immediate or high risk of closure. With a decline of physicians practicing in rural areas, and less access to hospital care, NPs can fill an urgent and growing need.


Finally, nurse practitioners are able to spend more time with patients, which can help patients feel heard and empowered. In a small University of Michigan study, patients reported that they felt that doctors “always” listened carefully 50% of the time compared to 80% of the time for NPs. This is not an admonishment of primary care physicians and the vital role they play, but highlights one of the institutional failures of our healthcare system.

Patients and the bottom line benefit from nurse practitioners being a part of the care team. Yet, NPs continue to fight bureaucracy to be granted full practice authority in many US states. Primary care shortages, inequities in access to care and the burden of chronic disease demand that we take action to implement a solution that already exists and is proven to affect both outcomes and costs.


About the author: Genevieve Swenson, COO and co-founder of Nice Healthcare, is a Family Nurse Practitioner with a diverse background in the healthcare world has partnered with patients in clinics, in their homes, via telehealth, in urgent cares and employer wellness clinics.

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