In this study, we examine how full nurse practitioner (NP) practice authority affects racial and ethnic diversity of the NP workforce. Specifically, the purpose of our research is to understand the relationship between the racial and ethnic composition of the NP workforce, NP level of practice authority, and the communities they service. In this paper, we compare the ethnic and racial composition of the NP workforce to the composition of the state's population, and then observe if there are any noticeable differences in the patients served by NPs when we compare full practice authority (FPA) and non-FPA states. We also estimate how FPA affects the race and ethnicity of Medicare patients served by NPs.
AdamsE. K.MarkowitzS. (2018). Improving efficiency in the health-care system: Removing anticompetitive barriers for advanced practice registered nurses and physician assistants. The Brookings Institution. Published June 13, 2018. Retrieved June 10, 2019.
2.
AlsanM.GarrickO.GrazianiG. (2019). Does diversity matter for health? Experimental evidence from Oakland. American Economic Review, 109(12), 4071–4111. https://doi.org/10.1257/aer.20181446
AshtonC. M.HaidetP.PaternitiD. A.CollinsT. C.GordonH. S.O’MalleyK.PetersenL. A.SharfB. F.Suarez-AlmazorM. E.WrayN. P.Street Jr.R. L. (2003). Racial and ethnic disparities in the use of health services. Journal of General Internal Medicine, 18(2), 146–152. https://doi.org/10.1046/j.1525-1497.2003.20532.x
AuerbachD. I.BuerhausP. I.StaigerD. O. (2020). Implications of the rapid growth of the nurse practitioner workforce in the US. Health Affairs, 39(2), 273–279. https://doi.org/10.1377/hlthaff.2019.00686
7.
BaeK.TimmonsE. (2022). Do restrictions on healthcare profession scope of practice help or harm US patients? In KleinerM. M.KoumentaM. (Eds.), Grease or sand?: Occupational licensing, efficiency, and service quality across nations (pp. 97–122). Upjohn Institute. https://doi.org/10.17848/9780880996877
8.
BarnesH.RichardsM. R.McHughM. D.MartsolfG. (2018). Rural and nonrural primary care physician practices increasingly rely on nurse practitioners. Health Affairs, 37(6), 908–914. https://doi.org/10.1377/hlthaff.2017.1158
9.
BayneE.NorrisC.TimmonsE. (2020). A primer on emergency occupational licensing reforms for combating COVID-19. Mercatus Center Policy Brief. Published March 26, 2020. Retrieved August 19, 2021.
10.
BenkertR.PetersR.TateN.DinardoE. (2008). Trust of nurse practitioners and physicians among African Americans with hypertension. Journal of the American Academy of Nurse Practitioners, 20(5), 273–280. https://doi.org/10.1111/j.1745-7599.2008.00317.x
11.
BurkeyY.ReeveH. (1997). Patients’ views on their discharge from follow up in outpatient clinics: Qualitative study. BMJ, 315, 1138–1141. https://doi.org/10.1136/bmj.315.7116.1138
12.
ChanK. S.ParikhM. A.ThorpeR. J.GaskinD. J. (2020). Health care disparities in race-ethnic communities of color and populations: Does the availability of health care providers play a role?Journal of Racial and Ethnic Health Disparities, 7, 539–549. https://doi.org/10.1007/s40615-019-00682-w
13.
ChenF. M.FryerG. E.PhillipsR. L.WilsonE.PathmanD. E. (2005). Patients’ beliefs about racism, preferences for physician race, and satisfaction with care. Annals of Family Medicine, 3(2), 138–143. https://doi.org/10.1370/afm.282
14.
CinelliC.ForneyA.PearlJ. (forthcoming). A crash course in good and bad controls. Sociological Methods & Research, Available ahead of print. https://doi.org/10.1177/00491241221099552
15.
CooperL.PoweN. R. (2004). Disparities in patient experiences, health care processes, and outcomes: the role of patient-provider racial, ethnic, and language concordance. Commonwealth Fund.
16.
DoescherM. P.AndrillaC. H. A.SkillmanS. M.MorganP.KaplanL. (2014). The contribution of physicians, physician assistants, and nurse practitioners toward rural primary care: Findings from a 13-state survey. Medical Care, 52(6), 549–556. https://doi.org/10.1097/MLR.0000000000000135
17.
ElliottM. N.MorrisonP. A.FremontA.McCaffreyD. F.PantojaP.LurieN. (2009). Using the census bureau’s surname list to improve estimates of race/ethnicity and associated disparities. Health Services and Outcomes Research Methodology, 9, 69–83. https://doi.org/10.1007/s10742-009-0047-1
18.
GaskinD. J.DinwiddieG. Y.ChanK. S.McClearyR. R. (2012). Residential segregation and the availability of primary care physicians. Health Services Research, 47(6), 2353–2376. https://doi.org/10.1111/j.1475-6773.2012.01417.x
19.
GrumbachK.MendozaR. (2008). Disparities in human resources: Addressing the lack of diversity in the health profession. Health Affairs, 27(2), 413–422. https://doi.org/10.1377/hlthaff.27.2.413
20.
Health Resources and Services Administration. (2021). What is a shortage designation?. U.S. Department of Health and Human Services. Updated February 2021. RetrievedAugust 21, 2021.
21.
HughesD. R.FilarC.MitchellD. T. (2022). Nurse practitioner scope of practice and the prevention of foot complications in rural diabetes patients. The Journal of Rural Health, 38(4), 994–998. https://doi.org/10.1111/jrh.12599
22.
JiangZ.MondscheinA. (2021). Analyzing parking sentiment and its relationship to parking supply and the built environment using online reviews. Journal of Big Data Analytics in Transportation, 3, 61–79. https://doi.org/10.1007/s42421-021-00036-1
MaA.SanchezA.MaM. (2019). The impact of patient-provider race/ethnicity concordance on provider visits: Updated evidence from the medical expenditure panel survey. Journal of Racial and Ethnic Health Disparities, 6, 1011–1020. https://doi.org/10.1007/s40615-019-00602-y
25.
MayedaD. P.WardK. T. (2019). Methods for overcoming barriers inn palliative care for ethnic/racial people of color: A systematic review. Palliative Supportive Care, 17(6), 697–706. https://doi.org/10.1017/S1478951519000403
26.
McMichaelB. J.MarkowitzS. (2020). Toward a uniform classification of nurse practitioner scope of practice laws. National Bureau of Economic Research. Working Paper No. 28192.
27.
National Center for Health Statistics. (2016). Health, United States, 2015: With special feature on racial and ethnic health disparities. U.S. Government Printing Office. Report No. 2016-1232.
28.
ParkJ.HanX.PittmanP. (2020). Does expanded state scope of practice for nurse practitioners and physician assistants increase primary care utilization in community health centers?Journal of the American Association of Nurse Practitioners, 32(6), 447–458. https://doi.org/10.1097/JXX.0000000000000263
29.
PatenE. Y.PettermannV.MarkB. A. (2019). Does state level nurse practitioner scope-of-practice affect access to care?Western Journal of Nursing Research, 41(4), 488–518. https://doi.org/10.1177/0193945918795168
30.
PoghosyanL.CarthonJ. M. B. (2017). The untapped potential of the nurse practitioner workforce in reducing health disparities. Policy, Politics, and Nursing Practice, 18(2), 84–94. https://doi.org/10.1177/1527154417721189
31.
PoghosyanL.PulciniJ.ChanG. K.DunphyL.MartsolfG. R.GrecoK.ToddB. A.BrownS. C.FitzgeraldM.McMenaminA. L.Solari-TwadellP. A. (2022). State responses to COVID-19: Potential benefits of continuing full practice authority for primary care nurse practitioners. Nursing Outlook, 70(1), 28–35. https://doi.org/10.1016/j.outlook.2021.07.012
32.
PoghosyanL.TimmonsE.AbrahamC. M.MartsolfG. R. (2019). The economic impact of the expansion of nurse practitioner scope of practice for medicaid. Journal of Nursing Regulation, 10(1), 1–6. https://doi.org/10.1016/S2155-8256(19)30078-X
33.
RothJ.Sant’AnnaP. H. C.BilinskiA.PoeeJ. (2022). What’s trending in difference-in-difference? A synthesis of the recent econometrics literature. ArXiv.https://doi.org/10.48550/arxiv.2201.01194
ShakyaS.PlemmonsA. (2020). Does scope of practice affect mobility of nurse practitioners serving medicare beneficiaries?Journal of Labor Research, 41(4), 421–434. https://doi.org/10.1007/s12122-020-09308-1
36.
SnyderC. R.FrognerB. K.SkillmanS. M. (2018). Facilitating racial and ethnic diversity in the health workforce. Journal of Allied Health, 47(1), 58–69.
37.
StanfordF. C. (2020). The importance of diversity and inclusion in the healthcare workforce. Journal of the National Medical Association, 112(3), 247–249. https://doi.org/10.1016/j.jnma.2020.03.014
38.
TimmonsE.NorrisC.MartsolfG.PoghosyanL. (2021). Estimating the effect of the New York state nurse practitioners modernization act on care received by medicaid patients. Policy, Politics, & Nursing Practice, 22(3), 212–220. https://doi.org/10.1177/15271544211018152
39.
WalkerK. O.MorenoG.GrumbachK. (2012). The association among specialty, race, ethnicity, and practice location among California physicians in diverse specialties. Journal of the National Medical Association, 104(1-2), 46–52. https://doi.org/10.1016/S0027-9684(15)30126-7
40.
XueY.HarelO. (2019). Imputing race and ethnic information in administrative health data. Health Services Research, 54(4), 957–960. https://doi.org/10.1111/1475-6773.13171
41.
XueY.YeZ.BrewerC.SpetzJ. (2016). Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review. Nursing Outlook, 64(1), 71–85. https://doi.org/10.1016/j.outlook.2015.08.005
42.
YangB. K.JohantgenM. E.TrinkoffA. M.IdzikS. R.WinceJ.TomlinsonC. (2021). State nurse practitioner practice regulations and U.S. health care delivery outcomes: A systematic review. Medical Care Research and Review, 78(3), 183–196. https://doi.org/10.1177/1077558719901216
