- The number of nurse practitioners in the U.S. more than doubled from 2010 to 2017, from about 91,000 to 190,000, according to a study published Monday in Health Affairs. The share of all Medicare evaluation and office visits billed by NPs and physician assistants grew from 4.6% to 12.3% in that period.
- An increasing number of NP education programs (from 356 in 2010 to 467 in 2017) that have attracted millennial nurses are driving this growth, according to the report. Such programs now collectively graduate nearly as many new NPs as medical schools do physicians each year.
- The increase led to an estimated loss of 80,000 registered nurses, and signals a potential shift of labor away from hospitals and into other primary care settings, researchers said.
While physician shortage concerns grow with an aging population, the increase puts into focus a burgeoning movement to grant nurse practitioners more autonomy. The study found that more care will be provided by NPs, inevitably, with projections for two NPs for every five physicians in 2030 — compared to less than one NP per five physicians in 2016.
The rise of nurse practitioners doesn't show any signs of slowing, according to the study. It found the number of NPs is expected to grow 6.8% each year from now until 2030. That's much faster than the projected increase in the number of physicians (1.1%) or PAs (4.3%).
The growth of NPs was most pronounced in outpatient centers, followed by physician offices and hospitals. That jibes with the continuing trend of moving more services and procedures away from inpatient settings.
The researchers recommend hospitals innovate and test ideas to replace RNs who have left their positions to become NPs, and find solutions to contend with tight or fluctuating RN staffing — as they have during past disruptions in their RN labor supply.
Health Affairs attributes the increase to a rapid expansion of NP educational programs, along with rapid growth in entry into NP programs. NP graduates more than tripled over the time period studied.
It may also be fueled by a reduction in the length of time between RN and NP education, as new RN graduates seem to be increasingly leaving hospital positions after only one or two years to pursue more advanced degrees, according to the study.
The delivery of NP education, however, is also changing. While it was once typical for RNs to obtain their NP education in programs that provided in-person lectures and extensive hands-on clinical experience and training, today's programs largely employ distance and online learning programs.
Data from the American Association of Colleges of Nursing found that 175 of the 376 NP education programs it analyzed are offered mostly online and 52 are offered completely online.
The Health Affairs study suggested researchers identify NPs' effectiveness and quality of care by level and type of educational preparation.