These days, getting an appointment with a healthcare provider can take weeks, and for many patients in rural or underserved areas, it may not even happen at all. While demand for healthcare in these areas continues to rise in the United States, the system is being forced to adapt to growing patient needs while facing an ongoing provider shortage. However, there is one solution that’s been the center of debate for decades: the independent practice of nurse practitioners without physician supervision, sparking the question of whether it should be allowed. As healthcare demands continue to grow, expanding the role of nurse practitioners through independent practice is a practical solution, as evidence shows they provide care comparable in quality to physicians, improve access in underserved communities, and help reduce healthcare costs, even though concerns about differences in training and patient safety remain part of the discussion.
Background on Nurse Practitioner and Practice Authority
A nurse practitioner (NP) is an advanced practice registered nurse who receives specialized training to assess patients, diagnose conditions, prescribe medications, and manage treatment plans. Their ability to carry out these skills is subject to scope-of-practice laws. These laws determine the level of autonomy nurse practitioners have in each state, with varying levels of authority across states. These levels of authority generally fall into three categories: full practice, reduced practice, and restricted practice. According to the American Association of Nurse Practitioners (2023), in states that allow full practice authority, the nurse practitioner may independently practice these skills without physician supervision, but under the exclusive licensure authority of the state board of nursing. While in states that allow reduced or restricted practices, varying levels of physician collaboration or supervision are required.
These restrictions on practice authority can limit efficiency and delay treatment, especially in areas already experiencing provider shortages. Research has shown that states with fewer restrictions tend to have a greater supply of nurse practitioners and improved access to care, particularly in underserved areas (Bae et al., 2024). Research from Auerbach et al. (2020) shows that a rapid increase in the nurse practitioner workforce reflects that expanding their role helps address healthcare gaps, particularly in primary care settings, where demands continue to rise. As these trends continue, restrictions on scope-of-practice laws may further limit the healthcare system’s ability to meet patient needs effectively, making it harder to justify the continued restriction of qualified providers.
Quality of Care Provided by Nurse Practitioners
The ability of a nurse practitioner to provide high-quality care is comparable to that of a physician. This makes it a key reason why nurse practitioners could be allowed to practice independently. Research consistently shows that in primary care settings, nurse practitioners are particularly effective at managing chronic conditions such as hypertension and diabetes, where consistent follow-up and patient engagement are critical (Htay & Whitehead, 2021). They are also effective at providing preventive care and treatment compared to physicians.
Furthermore, nurse practitioners often adopt a more holistic, patient-centered approach to care, which can further support positive health outcomes. That’s because these approaches include a greater emphasis on patient education, preventive care, and communication, all of which contribute to the long-term management of patient healthcare outcomes. These differences in nurse practitioner approaches also seem to affect patient satisfaction. Patient satisfaction tends to be high in nurse practitioner-led care, particularly in areas such as communication, time spent with patients, and overall experience (Hemp et al., 2026).
What makes this important is that strong patient-provider relationships can improve adherence to treatment plans and overall health outcomes. It reinforces the idea that the quality of care depends not only on the level of training but also on patient interaction and continuity of care. When both the clinical outcomes and patient satisfaction are comparable, the restrictions on nurse practitioner practice are not supported by evidence.
Improved Access to Healthcare
Many rural and underserved communities in the United States continue to face significant provider shortages, making it difficult for patients to receive timely care. These delays in care can worsen health conditions, leading to an increased reliance on emergency services. This highlights another key reason why the independence of nurse practitioners is so important, and its impact on access to care. According to Barnes et al. (2018), nurse practitioners are more likely to work in these areas, helping to fill critical gaps in care. Not only would this address the shortage of providers in primary care settings, but expanding nurse practitioners' scope of practice would also help reduce strain on emergency departments by allowing patients to receive care earlier, improving patient outcomes, and supporting more efficient use of healthcare resources.
Other studies, such as the study by Bae et al. (2024), provide a comparison of two states, one having independent practice for nurse practitioners and the other not, which showed that those in the state with fewer restrictions had a greater supply of providers and improved overall health outcomes. This provides deeper insight and demonstrates how expanding nurse practitioner independence can have not only a direct impact but also a measurable one on improving access to care.
As the demand for care in the United States continues to grow, especially with an aging population, expanding the number of accessible providers through nurse practitioner independence becomes an increasingly necessary solution (Auerbach et al., 2020). Without these changes, the gaps in access to care are more likely to widen, especially in already underserved regions.
Cost-Effectiveness of Nurse Practitioner Care
As the cost of healthcare in the United States continues to rise, nurse practitioner-led care has been shown to reduce costs while maintaining comparable outcomes. This makes overall healthcare costs another important reason for the independence of nurse practitioners. Research on Medicare patients found that care provided by nurse practitioners is associated with lower overall healthcare costs without compromising quality (Perloff et al., 2016). Similar findings have been reported in large healthcare systems, where patients assigned to nurse practitioners had lower healthcare costs than those assigned to physicians (Rajan et al., 2021).
This overall reduction in healthcare spending is due, as previously mentioned, to nurse practitioners often spending more time on patient education, preventive care, and chronic disease management, which can help reduce unnecessary emergency visits and hospitalizations over time. The continued growth of the nurse practitioner workforce also reflects a broader shift toward more cost-conscious models of care that prioritize accessibility and efficiency (Auerbach et al., 2020). These findings show that expanding nurse practitioners' independence could not only reduce unnecessary healthcare system costs but also lower the financial barriers patients face, all while maintaining effective, high-quality care.
Concerns About Training and Patient Safety
Those opposing the independent practice of nurse practitioners argue that they lack the same level of training as physicians, which some say could affect the safety and quality of patient care. Concerns about independent practice are often rooted in differences in education and clinical training, as physician training follows a highly standardized and prolonged pathway that includes medical school and residency, whereas nurse practitioner training varies in structure, clinical hour requirements, and program rigor (Chekijian et al., 2020). This leaves some to argue that independent practice may not be appropriate in all situations, such as patients with complex or high-risk conditions. While research by Norful et al. (2019) suggests that nurse practitioner-physician co-management models may improve coordination and quality of care, it also indicates that mandatory supervision of nurse practitioners is not necessary to maintain the quality of care.
However, while concerns about differences in training are valid and worth considering, they do not necessarily justify restricting nurse practitioners' independence. Nurse practitioners are trained within a defined scope of practice and are prepared to recognize when collaboration or a referral to an outside provider is necessary. Additionally, the assumption that less formal training results in lower-quality care is not supported by current evidence. Studies consistently show that nurse practitioners provide outcomes comparable to physicians in primary care settings, even when practicing independently (Bae et al., 2024). Furthermore, it is important to acknowledge that independence does not eliminate teamwork; it allows nurse practitioners to provide timely care while still collaborating with other healthcare professionals when appropriate, without compromising patient safety or health outcomes.
Conclusion
As the critical shortage of providers in the United States continues, nurse practitioners are a key part of the healthcare system and workforce, playing a vital role in addressing these challenges. They provide high-quality care, improve access for underserved populations, and help reduce healthcare costs without compromising patient outcomes. While concerns about differences in training are valid, they are not supported by evidence, as studies show no decrease in the quality or safety of care provided to patients by either nurse practitioners or physicians. Allowing nurse practitioners to practice independently is not about replacing physicians, but about strengthening the healthcare system. Expanding their role is a necessary step toward creating a more accessible, efficient, and patient-centered healthcare system.
References
American Association of Nurse Practitioners. (2023). State practice environment. https://www.aanp.org/advocacy/state/state-practice-environment
Auerbach, D. I., Buerhaus, P. I., & Staiger, D. 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
Bae, K., Norris, C., Shakya, S., & Timmons, E. (2024). Advanced practice registered nurse full practice authority, provider supply, and health outcomes: A border analysis. Policy, Politics, & Nursing Practice, 25(1), 6–13. https://doi.org/10.1177/15271544231212155
Barnes, H., Richards, M. R., McHugh, M. D., & Martsolf, G. R. (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
Chekijian, S. A., Elia, T. R., Horton, J. L., Baccari, B. M., & Temin, E. S. (2020). A review of interprofessional variation in education: Challenges and considerations in the growth of advanced practice providers in emergency medicine. AEM Education and Training, 5(2), e10469. https://doi.org/10.1002/aet2.10469
Hemp, N., Walker-Vischer, L., & Rose, J. (2026). Patient perception of nurse practitioner care, nurse practitioner scope of practice, and how that influences provider choice. Journal of the American Association of Nurse Practitioners, 38(2), 77–84. https://doi.org/10.1097/JXX.0000000000001204
Htay, M., & Whitehead, D. (2021). The effectiveness of the role of advanced nurse practitioners compared to physician-led or usual care: A systematic review. International Journal of Nursing Studies Advances, 3, Article 100034. https://doi.org/10.1016/j.ijnsa.2021.100034
Norful, A. A., Swords, K., Marichal, M., Cho, H., & Poghosyan, L. (2019). Nurse practitioner–physician comanagement of primary care patients: The promise of a new delivery care model to improve quality of care. Health Care Management Review, 44(3), 235–245. https://doi.org/10.1097/HMR.0000000000000161
Perloff, J., DesRoches, C. M., & Buerhaus, P. (2016). Comparing the cost of care provided to Medicare beneficiaries assigned to primary care nurse practitioners and physicians. Health Services Research, 51(4), 1407–1423. https://doi.org/10.1111/1475-6773.12425
Rajan, S. S., Akeroyd, J. M., Ahmed, S. T., Ramsey, D. J., Ballantyne, C. M., Petersen, L. A., & Virani, S. S. (2021). Health care costs associated with primary care physicians versus nurse practitioners and physician assistants. Journal of the American Association of Nurse Practitioners, 33(11), 967–974. https://doi.org/10.1097/JXX.0000000000000555
