New Paper Thread!

Nurse Practitioner Autonomy and Complexity of Care in Rural Primary Care https://journals.sagepub.com/doi/10.1177/1077558720945913

This @MCRRSage piece was a super fun @UMNRHRC collaboration with @Laura2smith Bethany Sheridan of @athenahealth
@IMoscovice @shaileyprasad @katybkoz

Bottom line: Primary care NPs in rural areas practice with greater autonomy than urban NPs.

…in every way we could measure: having an independent patient panel, billing independently, seeing patients without a physician present in the office, and prescribing Schedule II controlled substances.

We used detailed claims and EHR-based data from @athenahealth to measure NP practice autonomy…and our findings line up really well with survey evidence from @JoanneSpetz and others.

NERD ALERT: For you data-enthusiasts on here, I’ll just say that we were able to observe the rendering and billing clinicians…which helped get around the fact that NP-provided care can’t always be distinguished from physician-provided care in claims data.

Interestingly, one similarity between rural and urban NPs: complexity of care

…no differences in average work RVUs or E&M intensity (compared to the physicians in their practices)

So, what’s it all mean? NPs are a rapidly-growing part of primary care, especially in rural areas. We know that practice autonomy is strongly tied to job satisfaction…the ability to work “at the top of their license” may help draw NPs to rural practice.