By Justin Leventhal, American Consumer Institute
When it comes to expanding access to healthcare, few reforms are as obvious—and as overdue—as giving nurse practitioners the freedom to practice to the full extent of their training. Across the country, patients wait weeks for a primary care appointment, and costs continue to climb. Yet in Texas and other states, laws protecting physicians from competition prevent nurse practitioners from filling the gap. By modernizing scope-of-practice rules, states could expand patient access to primary care, lower costs for patients, and maintain high-quality outcomes. The only cost would be dismantling a protectionist system lobbied for by doctors that professional self-interest above the health of the public.
Doctors, like any special interest, are financially benefited by preventing competition. The American Medical Association (AMA), which lobbies on behalf of physicians, boasts that it helped block 80 state bills to expand practice authority for other healthcare professionals in 2024, and more than 100 others in 2023. When non-physician providers gain authority, it means more competition. Nurse practitioners (NPs) in particular threaten the dominance of doctors in primary care by offering the same quality service at lower cost.
To be clear, there are many things only doctors are properly trained to do—surgery, cancer treatment, and other complex specialties require years of highly specific education. But routine check-ups and primary care can be delivered just as effectively by other qualified professionals, including NPs. Despite an anticipated shortage of 87,150 primary care physicians, the AMA continues to oppose any expansion of NP practice authority in diagnosis or treatment.
The evidence says otherwise. States that grant NPs full practice authority have reduced the use of costly emergency departments, increased medicine adherence, and more patient education. In states with full practice authority for NPs, there are 22.4 more NPs per 100,000 people, and declining reports of poor health. Outcomes have not deteriorated in these states—instead, access expanded, costs fell, and even physician malpractice payouts dropped.
Allowing NPs to practice independently not only increases access, it also lowers costs. Primary care delivered by physicians costs 34 percent more than the same care from an NP. Full practice authority has boosted rural healthcare access, cut primary care costs by 11 percent, shortened average wait times by eight days, and reduced hospitalization for manageable chronic conditions by seven to 12 percent. Expanding NPs practice authority is particularly effective at reducing the healthcare costs of common diseases—in the case of diabetes by 20 percent in urban areas and 10 percent in rural ones.
The benefits for the state of Texas alone would be striking. Granting full practice authority for advanced practice registered nurses would cut the state’s primary care shortage by 32 percent, save $47.7 million over two years, and increase Texas’ GDP by half a billion dollars through the 4,000 new jobs it would create in the first year alone. That’s a win for patients and providers.
Repeatedly research has confirmed that NP primary care is just as effective as physician-led primary care. A randomized trial found no difference in key health metrics. Another study found that across 11 separate metrics of quality, safety, and effectiveness, NPs matched or exceeded physicians. A review of the research found no study showing worse outcomes from NP primary care—and many showing better outcomes and lower costs.
The evidence is clear: patients benefit when NPs are free to practice primary care without unnecessary physician oversight. Twenty-seven states and Washington D.C. have already expanded NPs’ authority, expanding access to care. Yet current laws leave physicians with a monopoly on primary care in 23 states. Expanding the role of NPs in the healthcare system is not about diminishing physicians, but about recognizing that modern healthcare requires every qualified provider working at the top of their training, or we may all be facing months long waits to see our primary care doctors soon.
Justin Leventhal is a senior policy analyst for the American Consumer Institute, a nonprofit education and research organization that advocates for consumers through evidence-based analysis and data.