Abstract
The purpose of this study is to examine the effects of State regulation that determines the extent of professional independence of advanced practice nurses (APNs). 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 (PAs) are substantially higher, than in other States. These results are striking since PAs are in direct competition with APNs; the only real operational difference between these groups is that PAs 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 PAs. The finding that earnings of APNs decline when they attain more professional autonomy vis-à-vis physicians reinforces work by Sass and Nichols on physical therapists.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Adams, A. Frank III, Robert B. Ekelund Jr., and John D. Jackson. 2003. ‘‘Occupational Licensing of a Credence Good: The Regulation of Midwifery.’’ Southern Economic Journal: 69(3): 659.
Francine Blau D Marianne A Ferber Anne E Winkler (1998) The Economics of Women, Men, and Work Prentice Hall Upper Saddle River, New Jersey
Lavonne Booton A Julia I Lane (1985) ArticleTitle‘‘Hospital Market Structure and the Return to Nursing Education’‘ Journal of Human Resources 20 184–195
Reginald Carter (2001) ArticleTitle‘‘Physician Assistant History’‘ Perspective on Physician Assistant Education 12 IssueID2 130–132
Eugene Declerq R Lisa Diana L. Paine Jeanne R. Simmes F Joseph ParticleDe (1998) ArticleTitle‘‘State Regulation, Payment Policies, and Nurse-Midwife Services’‘ Health Affairs 17 IssueID2 190–200
Freudenheim, Milton. 1997. “Nurses Working Without Doctors Angers the Medical Establishment.” The New York Times, page A1, C4, September 30.
Art Goldsmith (1989) ArticleTitle‘‘Dental Hygienists’ Wages: The Role of Human Capital and Institutional Factors’‘ Quarterly Review of Economics and Business 29 56–67
Graddy Elizabeth (1991) ArticleTitleInterest Groups or the Public Interest -- “Why Do We Regulate Health Occupations? Journal of Health Politics, Policy and Law 16 IssueID1 25–49
Harper, Doreen C., and Jean Johnson. 1998. ‘‘The New Generation of Nurse Practitioners: Is More Enough?’’. Health Affairs 17(5): 157-164.
Ada Jacox (1988) ‘‘Nurse Practitioners, Nurse Midwives, and Clinical Nurse Specialists’’. Nursing Resources and the Delivery of Patient Care NIH Publication 89-3008 NCNR, DHS
Ayah Johnson Julie Sochalski Marshall Fritz William Spencer (2000) ‘‘The Registered Nurse Population March 2000: Findings from the National Sample Survey of Registered Nurses’’. U.S. Department of Health and Human Services Washington
Leccese, Christine. 1998. ‘‘Who’s Making What and Where: The ADVANCE Salary Survey’’. (January) ADVANCE for Nurse Practitioners .
L Evelyn Lehrer William D White Wendy B Young (1991) ArticleTitle‘‘The Three Avenues to a Registered Nurse License: A Comparative Analysis’‘ Journal of Human Resources 26 362–379
R Charles Link (1988) ArticleTitle‘‘Returns to Nursing Education: 1970-“1984’‘ Journal of Human Resources 23 373–387
Maas, M., J. Specht, and A. Jacox, 1975. ‘‘Nurse Autonomy: Reality not Rhetoric’’. (December) American Journal of Nursing .
G.S. Maddala (1993) Limited-Dependent and Qualitative Variables in Econometrics EditionNumber2 Cambridge University Press Cambridge
J Diana Mason Sally S Cohen Jeffrey P. O’Donnell Kathy Baxter Ann B Chase (1997) ArticleTitle‘‘Managed Care Organizations’ Arrangements with Nurse Practitioners’‘ Nursing Economics 15 IssueID6 306–314
T Stephen Mennemeyer Gary Gaumer (1983) ArticleTitle‘‘Nursing Wages and the Value of Educational Credentials’‘ Journal of Human Resources 18 32–48
A Morgan Walter (1993) ArticleTitle‘‘Using State Board of Nursing Data to Estimate the Number of Nurse Practitioners in the United States’‘ Nurse Practitioner 18 IssueID2 65–74
Nichols, Len M. 1992. ‘‘Estimating Costs of Underusing Advanced Practice Nurses’’. Nursing Economics 10(5): (September-October).
InstitutionalAuthorNameOffice of Technology Assessment (1986) Nurse Practitioners, Physicians’ Assistants, and Certified Nurse-midwives: A Policy Analysis Health Technology Case Study No. 37 Washington D.C.: U.S. Government Printing Office
Chris Paul (1984) ArticleTitle‘‘Physician Licensure Legislation and the Quality of Medical Care’‘ Atlantic Economic Journal 12 IssueID4 18–30
J Pearson Linda (2003) ArticleTitle‘‘Fifteenth Annual Legislative Update: How Each State Stands on Legislative Issues Affecting Advanced Nursing Practice’‘ Nurse Practitioner 28 IssueID1 26–32
Sam Peltzman (1976) ArticleTitle‘‘Toward a More General Theory of Regulation’‘ Journal of Law and Economics 19 IssueID2 211–248
Prescott, P., A. Jacox, M. Collar, and L. Goodwin. 1981. ‘‘The Nurse Practitioner Rating Form - Part I: Conceptual Development and Potential Use, and Part II: Methodological Development’’. Nursing Research (July-“August and September-“October).
A Prescott Patricia (1994) ArticleTitle‘‘Cost-effective Primary Care Providers: An Important Component of Health Care Reform’‘ International Journal of Technology Assessment in Health Care 10 IssueID2 249–257
Lillian Randolph (1997) Physician Characteristics and Distribution in the US 1997-“1998 American Medical Association Dover, Delaware
Sherwin Rosen (1992) ArticleTitle‘‘The Market for Lawyers’‘ Journal of Law and Economics 35 215–246
InstitutionalAuthorNameDivision of Nursing (1996) The Registered Nurse Population: Findings from the National Sample Survey of Registered Nurses U.S. Department of Health and Human Services Washington, D.C
Safriet, Barbara J. 1992. ‘‘Health Care Dollars and Regulatory Sense: The Role of Advanced Practice Nursing’’, Yale Journal on Regulation 9: 417--“488.
R Sass Tim Mark W Nichols (1996) ArticleTitle‘‘Scope-of-Practice Regulation: Physician Control and the Wages of Non-Physician Health-Care Professionals’‘ Journal of Regulatory Economics 9 61–81
Schumacher, Edward J., ‘‘Relative Wages and the Returns to Education in the Labor Market for Registered Nurses’’, Research in Labor Economics (forthcoming).
J Schumacher Edward Barry T Hirsch (1997) ArticleTitle‘‘Compensating Differentials and Unmeasured Ability in the Labor Market for Nurses: Why Do Hospitals Pay More’‘ Industrial and Labor Relations Review 50 IssueID4 557–579
S Sekscenski Edward Stephanie Sansom Carol Bazell Marla E Salmon Fitzhugh Mulllan (1994) ArticleTitle‘‘State Practice Environments and the Supply of Physician Assistants, Nurse Practitioners, and Certified Nurse-Midwives’‘ New England Journal Of Medicine 331 1266–1271
J Stigler George (1971) ArticleTitle‘‘The Theory of Economic Regulation’‘ Bell Journal of Economics 2 IssueID1 3–21
Ventura, Marissa J. 1997. ‘‘The 1997 Earnings Survey: Slow Gains, High Earnings’’. RN (October): 40--“47.
J. Weston (1980) ArticleTitle‘‘Distribution of Nurse Practitioners and Physician Assistants: Implications of Legal Constraints and Reimbursement’‘ Public Health Reports 95 IssueID3 253–258
M Wooldridge Jeffrey (2003a) ArticleTitle‘‘Cluster-Sample Methods in Applied Econometrics’‘ American Economic Review 93 IssueID2 133–138
M Wooldridge Jeffrey (2003b) Introductory Economics: A Modern Approach, 2e Southwestern/Thomson Learning Mason, Ohio
Author information
Authors and Affiliations
Additional information
The content is the responsibility of the authors and does not represent official positions of the Federal Reserve Bank of St. Louis or the Federal Reserve System
JEL classification: I11, I18, J31, J44, L51
Rights and permissions
About this article
Cite this article
Dueker, M.J., Jacox, A.K., Kalist, D.E. et al. The Practice Boundaries of Advanced Practice Nurses: An Economic and Legal Analysis. J Regul Econ 27, 309–330 (2005). https://doi.org/10.1007/s11149-005-6626-3
Issue Date:
DOI: https://doi.org/10.1007/s11149-005-6626-3