Advanced practice nurses have been providing medical care to patients since Loretta Ford pioneered the field in 1965. Physicians have long argued that nurse practitioners lack the training and skill to identify and manage complex illnesses. Despite fallout from the medical community, nurse practitioners have seen great success as they produce clinical outcomes and patient satisfaction levels comparable to that of physicians for overall health management, diabetes and hypertension. Once regulated and required to work directly under a physician, today’s advanced practice nurses are gaining greater autonomy thanks to a shifting provider-patient landscape: There are just not enough physicians to go around.

The implementation of the Affordable Care Act has introduced some 30 million Americans to health care they never had. Combine this influx of patients with aging, retiring physicians and very few new physicians choosing to go into primary care, and the situation is challenging. Researchers estimate that by 2020, the United States could have a shortage of up to 200,000 primary care physicians. The current shortage leaves the U.S. more than 6,000 primary care practitioners behind, with the remaining few seeing about 3,500 patients each — far too many for one physician to manage without significant problems for the patient, including long waits for an appointment and shorter time with the physician.

Primary care providers are especially scarce in southern and rural areas of the country where there may not be a primary care provider for miles — a situation that drives down access and forces patients to travel great distances for medical care. To combat this problem, the nation is looking to nurse practitioners to fill the void.

More States Passing Legislation to Reduce Restrictions

Nurse practitioners can be trained more quickly than physicians, cost less to employ and still produce positive clinical outcomes. Between 3 and 12 nurse practitioners can be educated for the cost of one physician. Despite the NP’s ability to prove their worth, many states in the U.S. continue to restrict their scope of practice. Currently, 19 states and the District of Columbia allow nurse practitioners to work without oversight or collaboration with a physician. Another 19 let nurse practitioners practice with semi-independence — calling on physician collaboration for specific criteria, like prescribing pain medication. Twelve states have considered legislation to give NPs more autonomy and do away with physician oversight.

In 2010, the Institute of Medicine (IOM) recommended that states broaden the NP’s scope of practice allowing them to use the full extent of their training and boost effective primary care. The group also encouraged the removal of insurance, legislative and regulatory barriers that would prevent nurse practitioners from practicing to their full extent. Most recently, New York and Kentucky passed legislation allowing nurses to work without a physician practice agreement. New York’s NPs with less than 3,600 practice hours will need to continue the physician practice agreement until they reach the minimum number of practice hours. As of July 2014, Kentucky nurse practitioners who have completed a four-year collaboration with a physician are authorized to prescribe routine medications without a doctor’s involvement — the result of five years of legislative debate.

Nurse Practitioners Face a Bright Future

According to the American Association of Nurse Practitioners (AANP), there are 155,000 NPs in the United States, and that number is expected to balloon to 244,000 by the year 2025. Nurses looking to advance into a nurse practitioner role have more flexible and convenient educational options than ever, allowing them to continue working and earn a Master of Science degree in Nursing at the same time.

“The sky’s the limit for nurse practitioners,” says David Hebert, CEO of the American Association of Nurse Practitioners in an interview with Modern Healthcare online.

As more states consider legislation to improve autonomy, a greater number of patients gain access to quality care they may not have been able to access otherwise, and nurse practitioners will continue to support their health — without a physician over their shoulder.