nurse practitioner reform pennsylvania

Expanding Health Care Access: The Easy Way

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Key Findings

  • Full practice authority for nurse practitioners (NPs) would increase the amount of time NPs can see patients by about 45 minutes each week.
    • This translates into almost one more week of patient access per NP per year, or approximately an additional 109 patients per NP each year.
    • This is a conservative estimate given the calculation excludes patients likely seen by new NPs and other efficiency gains.
  • Full practice authority trends towards higher rates of NP self-employment and indicates a greater shift to full-time work for the full year for both physicians and NPs.
  • Full practice authority results in a statistically significant increase in NP earnings of $3,535 (approximately 4 percent), while physician earnings show no statistically significant change.

Executive Summary

Patients who receive timely primary and preventive care are less likely to have expensive emergency department visits and unnecessary hospitalizations. This, in turn, saves money for patients and taxpayers. But Pennsylvania’s supply of primary care is inadequate and getting worse due to increasing physician burnout and an aging population.[1]

According to the Human Resources and Services Administration (HRSA), an estimated 14 percent of Pennsylvanians live in an area designated as medically underserved. Nearly every Pennsylvania county contains a shortage of primary care providers.[2]

Many proposals to better health care access, such as expanding Medicaid eligibility, focus on increased access to coverage of health care services. But these reforms are unhelpful if the newly insured cannot access providers.[3] In other words, adding more patients without more providers does little to expand health care access.

Pennsylvania’s scope of practice regulations, set by state licensing boards, forbid NPs from practicing without expensive physician collaboration contracts. This additional administrative burden reduces the number of patients existing NPs can help.[4]

Allowing full practice authority would also increase the number of available primary care providers in rural communities.[5] There is evidence that weekly work hours across all primary care jobs are higher in full practice authority states.[6]

The full report estimates the effects of granting full practice authority to NPs in Pennsylvania on various labor market and economic outcomes of physicians and NPs. Notable findings include:

  • Full practice authority improves the labor market for NPs as passage results in a statistically significant increase in earnings of $3,535, or approximately 4 percent. Physicians do not see a statistically significant change in earnings under full practice authority.
  • There is a statistically significant increase of three-quarters of an hour worked per week for NPs. For physicians, findings show a statistically significant decrease in usual hours worked per week of about twenty minutes.
  • The increase in working hours means that NPs can see an additional two patients per week, or approximately 109 additional patients per year.
  • Full practice authority is associated with NPs shifting their working habits from part-time to full-time. The findings show a similar pattern of more work hours for physicians, moving from full-time part of the year to full-time all year.


Pennsylvania NPs cannot practice without expensive collaboration contracts. These restrictions may cause inefficiencies in the health care system and exasperate access issues. Granting full practice authority would allow NPs to see more patients in the neediest areas without impacting the earnings of physicians. This policy change is an important start in expanding health care access and improving health outcomes in Pennsylvania.

Download the full report here.

[1]Alexis R. Santos and Raeven Faye Chandler, “Ambulatory and Cognition Challenges Among Older Pennsylvanians,” Penn State Pennsylvania Population Network, No. 12 (February 2022),; Matthias Weigl, “Physician Burnout Undermines Safe Healthcare,” British Medical Journal (BMJ), September 14,2022,

[2]Drexel News, “New Research Shows Disparities Limiting Access to Health Care Services, Including COVID-19 Vaccines, In Pennsylvania’s Underserved Communities,” Synopsis: “Disrupting Disparities in Pennsylvania” [Pennsylvania AARP and Drexel University, White paper (2021)], April 5, 2021,

[3]Benjamin Sommers, et al., “Three-Year Impacts of the Affordable Care Act: Improved Medical Care and Health among Low-Income Adults,” Health Affairs 36, No. 6 (June 2017), 1119–28,

[4]Ryan Kandrack, Hilary Barnes, and Grant R. Martsolf, “Nurse Practitioner Scope of Practice Regulations and Nurse Practitioner Supply,” Medical Care Research and Review 78, No. 3 (June 2021), 208–17,

[5]Hilary Barnes, et al., “Rural and Nonrural Primary Care Physician Practices Increasingly Rely on Nurse Practitioners,” Health Affairs 37, No. 6 (June 2018), 908–14,

[6]Sara Markowitz and E. Kathleen Adams, “The Effects of State Scope of Practice Laws on the Labor Supply of Advanced Practice Registered Nurses,” American Journal of Health Economics 8, No. 1 (Winter 2022), 65–98,