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Does Scope of Practice Affect Mobility of Nurse Practitioners Serving Medicare Beneficiaries?

Abstract

The shortage of nurse practitioners in the United States has broadly decreased access, decreased quality, and increased care costs. In some states, policymakers are trying to address such shortages by expanding nurse practitioners’ scope of practice or extending autonomy for nurses to order tests, prescribe medications, diagnose patients, and initiate and manage treatments. We exploit the state-level variations in the nurse practitioner’s scope of practice laws to estimate the impact on the mobility decisions of the nurse who serve Medicare beneficiaries. We identify nurse’s practice locations from 2013 to 2017 by gleaning their National Provider Identifiers from Part D Prescriber Public Use File data. We find that nurses in full-practice states are 0.41 percent less likely to move out of the state compared to nurses in restrictive-practice states. Also, nurses who move are 5.70 percent more likely to move to full-practice states than restrictive-practice states. Our estimates demonstrate nurses’ preference for practicing in states with the full scope of practice.

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Fig. 1

Notes

  1. Hall and Shakya (2019) try to reconcile these two theories and demonstrate an inverted-U-shaped relation of regulation to industry growth. In contrast, Scarcioffolo et al. (2020) show that some regulations can be expressive without the significant effects in the industry.

  2. For ease of readability for readers, the state by state regimes shown in Fig. 1 are repeated in Table 6 within the appendix.

  3. https://npiregistry.cms.hhs.gov/

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Correspondence to Shishir Shakya.

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Appendix

Appendix

Table 6 State regime

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Shakya, S., Plemmons, A. Does Scope of Practice Affect Mobility of Nurse Practitioners Serving Medicare Beneficiaries?. J Labor Res 41, 421–434 (2020). https://doi.org/10.1007/s12122-020-09308-1

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Keywords

  • Scope of practice
  • Nurse practitioners
  • Regulation
  • Mobility

JEL Classification

  • J44
  • I18
  • H75