Nonphysician Clinicians

Scope of Practice for NPs and PAs

This blog has been a proponent of increased use of nurse practitioners and physician assistants to reduce the cost of health care.  However, do they really reduce the cost of care?  On the one hand, NPs and PAs cost less than physicians.  On the other hand, if patients must visit an NP/PA and then a doctor for most conditions, costs would rise.  Also cost would increase if the use of NPs/PAs increased hospitalization rates.

A study by Spetz et al. finds that NPs and PAs are cost saving in retail clinics.

Our results are consistent with prior research that found that retail clinic care was associated with lower total costs, compared to the cost of care received in other settings such as physician offices, urgent care clinics, and emergency departments, and that there was no indication that these clinics increased subsequent hospitalizations, compared to nonretail clinics.

However, some states allow NPs and PAs to practice independently, while other states require that they be supervised by or collaborate with physicians.  This requirement prohibiting independent practice has a direct effect on cost.

We also found that when NPs were allowed to practice independently, the cost savings of retail clinic episodes were even greater than when they could not practice independently.



  1. I think good NP/PA’s can certainly help reduce costs in the right care model. They need to have good support available for anything outside their comfort zone but for simple check ups, follow ups, bumps/scraps they are great for Primary Care support.

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