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The practice boundaries of advanced practice nurses: an economic and legal analysis

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  • Michael J. Dueker
  • Ada K. Jacox
  • David E. Kalist
  • Stephen J. Spurr

Abstract

The purpose of this study is to examine the causes and effects of State regulation that determines the extent of professional independence of advanced practice nurses (APNs). We analyze determinants of these regulations in panel data across States. We find that in States where APNs have acquired a substantial amount of professional independence, the earnings of APNs are substantially lower, and those of physicians' assistants are substantially higher, than in other States. These results are striking since physicians' assistants are in direct competition with APNs; the only real operational difference between these groups is that physicians' assistants are salaried employees who must work under the supervision of a physician. The implication is that physicians have responded to an increase in professional independence of APNs by hiring fewer APNs and more physicians' assistants.

Suggested Citation

  • Michael J. Dueker & Ada K. Jacox & David E. Kalist & Stephen J. Spurr, 2005. "The practice boundaries of advanced practice nurses: an economic and legal analysis," Working Papers 2005-071, Federal Reserve Bank of St. Louis.
    • Handle: RePEc:fip:fedlwp:2005-071
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    Cited by:

    1. Malakhov, Vladimir Sergeevich (Малахов, Владимир Сергеевич), 2016. "Evaluation of Risks, Threats and Challenges of Migration Policy in the Context of Long-Term Mass Presence on the Territory of Russian Refugees from Neighboring Countries [Оценка Рисков, Угроз И Зад," Working Papers 16610, Russian Presidential Academy of National Economy and Public Administration.
    2. Stange, Kevin, 2014. "How does provider supply and regulation influence health care markets? Evidence from nurse practitioners and physician assistants," Journal of Health Economics, Elsevier, vol. 33(C), pages 1-27.
    3. John J. Perry, 2009. "The Rise And Impact Of Nurse Practitioners And Physician Assistants On Their Own And Cross‐Occupation Incomes," Contemporary Economic Policy, Western Economic Association International, vol. 27(4), pages 491-511, October.
    4. Patricia Pittman & Benjamin Williams, 2012. "Physician Wages in States with Expanded APRN Scope of Practice," Nursing Research and Practice, Hindawi, vol. 2012, pages 1-5, February.
    5. Morris M. Kleiner & Allison Marier & Kyoung Won Park & Coady Wing, 2016. "Relaxing Occupational Licensing Requirements: Analyzing Wages and Prices for a Medical Service," Journal of Law and Economics, University of Chicago Press, vol. 59(2), pages 261-291.
    6. John J. Perry, 2012. "State-Granted Practice Authority: Do Nurse Practitioners Vote with Their Feet?," Nursing Research and Practice, Hindawi, vol. 2012, pages 1-5, November.
    7. William H. Greene & David A. Hensher, 2008. "Modeling Ordered Choices: A Primer and Recent Developments," Working Papers 08-26, New York University, Leonard N. Stern School of Business, Department of Economics.
    8. McMichael, Benjamin, 2017. "Beyond Physicians: The Effect of Licensing and Liability Laws on the Supply of Nurse Practitioners and Physician Assistants," Working Papers 07538, George Mason University, Mercatus Center.
    9. Anca M. Grecu & Lee C. Spector, 2019. "Nurse practitioner's independent prescriptive authority and opioids abuse," Health Economics, John Wiley & Sons, Ltd., vol. 28(10), pages 1220-1225, October.
    10. Park, Jee-Hyeong & Spurr, Stephen J. & Chang, Sheng-Kai, 2009. "A Model of Hierarchical Professionals: Cooperation and Conflict between Anesthesiologists and CRNAs," CEI Working Paper Series 2009-13, Center for Economic Institutions, Institute of Economic Research, Hitotsubashi University.
    11. Alexander, Diane & Schnell, Molly, 2019. "Just what the nurse practitioner ordered: Independent prescriptive authority and population mental health," Journal of Health Economics, Elsevier, vol. 66(C), pages 145-162.
    12. Benjamin J. McMichael, 2017. "The Demand for Healthcare Regulation: The Effect of Political Spending on Occupational Licensing Laws," Southern Economic Journal, John Wiley & Sons, vol. 84(1), pages 297-316, July.
    13. Tianyuan Luo & Cesar L. Escalante & Carmina E. Taylor, 2021. "Labor market outcomes of granting full professional independence to nurse practitioners," Journal of Regulatory Economics, Springer, vol. 60(1), pages 22-54, August.

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