Study: Advanced practice nurses gaining in turf war with physicians

Since the early 1900s, physicians have traditionally dominated the field of medicine, possessing the power to determine who can provide which services and largely influencing the laws controlling medical practice in each state.

This started to change in the latter half of the 20th century, as cost containment became a large concern for policymakers, organizations and patients alike. Managed care started exerting influence over payment for health care services. What's more, physician shortages created additional needs for advanced practice nurses (APNs), who have more education and specialized training than registered nurses.

To determine the extent to which physician dominance has eroded since the start of the 21st century, researchers at Florida Atlantic University and Iowa State University analyzed 17 years of data.

"What we are seeing is that the public is becoming more comfortable with advanced practice nurses, and this is starting to be reflected more in state policies around the country," said Scott Feyereisen, Ph.D., lead author of the study and an assistant professor in health administration in FAU's College of Business. "While physicians are still viewed as powerful, the growing need for health care providers is winning."

The study, published in the Sociology of Health & Illness journal, did find that physician dominance was declining. However, only in less prestigious medical specialties, such as general practice and OB-GYN. So far, physicians have been successfully defending their turf in more prestigious specialties like anesthesiology, which is largely seen to be one of the most prestigious (and highest-paying) fields to be challenged by APNs.

APNs not only have different levels of autonomy in each field, but it also varies widely among states. Access to care can vary widely based on the extent to which APNs are able to work on their own in accordance with their training.

"What is fascinating about these results is that there are states where physician shortages exist, yet they still offer advanced practice nurses very little autonomy," said Neeraj Puro, Ph.D, a study co-author and assistant professor of health administration at FAU. "We think that states could improve their ability to offer more health care services by increasing the ability of APNs to practice to the full extent of their training."

Feyereisen and Puro worked on the study with FAU's William McConnell, Ph.D., an assistant professor of sociology, and Clayton Thomas, Ph.D., an assistant professor at Iowa State.

In conducting the study, the researchers reviewed scope of practice laws governing APNs for all 50 states from 2001-2017. Laws governing all four types of advanced practice nurses were considered: nurse practitioners, nurse anesthetists, certified nurse specialists and nurse midwives.