AANP Responds to Recent Article in Bloomberg News

This letter was sent to Bloomberg News for publication on July 29, 2024.

To the editor:

The American Association of Nurse Practitioners® (AANP) is writing to address the recent article, "The Miseducation of America’s Nurse Practitioners." In a recent podcast, one of the authors of this article stated that “A bad reading of the story would be nurse practitioners bad, which is not what the story says.” However, the authors have failed to write a balanced story by cherry picking negative information and failing to report the enormous contributions nurse practitioners (NPs) make to patient care and across the health care system.

The authors have omitted the fact that NPs have consistently risen to meet our nation's health care challenges — including risking their lives with other health care professionals to treat patients during the pandemic despite a limited supply of personal protective equipment (PPE); setting up mobile clinics or going door to door in disadvantaged communities to provide care; being among the first clinicians to treat patients with opioid use disorder in hundreds of rural counties; and providing care in rural counties, after other clinicians left and hospitals closed, to ensure continued access.

Unfortunately, these types of hit pieces can be written about any profession, but distinctly have no place in our nation’s health care system. This type of journalism not only disparages an honorable profession at a time in which our country is struggling to build our nation’s workforce, but also frightens patients from seeking needed care.

The following points were either provided by AANP or could have been easily found by the authors if they were seeking to provide readers with any type of balanced article:

• The authors only included one study, which they appeared to discredit by saying it included international NPs. In fact, AANP provided more than 50 studies that definitively demonstrate that NPs in the United States provide high-quality primary, acute and specialty health care services across the lifespan and in diverse settings.
• Multiple leading health care experts and health policy leaders have evaluated the evidence on NP care and have recommended removing barriers that patients face when seeing NPs. These include the following examples:
  • The National Academies of Science, Engineering and Medicine’s report on the future of nursing found that: “Such restrictions limit access to care generally and to the high-quality care offered by APRNs. Those supporting these restrictions maintain that nonphysician providers are less likely to provide high-quality care because they are required to receive less training and clinical experience. However, evidence does not show that scope-of-practice restrictions improve quality of care (Perloff et al., 2019; Yang et al., 2020). Rather, these regulations restrict competition and can contribute to higher health care costs (Adams and Markowitz, 2018; Perloff et al., 2019).” (National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity.)
  • The American Enterprise Institute wrote: “Can NPs provide health care of comparable quality to that provided by primary care physicians? Our studies showed that beneficiaries who received their primary care from NPs consistently received significantly higher-quality care than physicians’ patients in several respects. While beneficiaries treated by physicians received slightly better services in a few realms, the differences were marginal. These results held when vulnerable populations of Medicare beneficiaries were analyzed separately and compared to those cared for by physicians, aligning with the findings of many other studies conducted over the past four decades.” (American Enterprise Institute. 2018. Nurse Practitioners: A Solution to America’s Primary Care Crisis.)
  • The Brookings Institution wrote: “Opponents contend that quality of care may suffer under the direction of a nonphysician practitioner, citing the shorter length of training and clinical experience required. Their argument is that restrictions are necessary to protect public health. However, academic literature finds no evidence of harm to patients associated with less-restrictive Scope of Practice (SOP) laws. When no harm is present, the restrictions serve only to generate artificial barriers to care that ultimately provide physicians with protection from competition, prevent the attainment of system-wide efficiencies, and constrain overall provider capacity.” (The Hamilton Project. Brookings. 2018. Improving Efficiency in the Health-Care System: Removing Anticompetitive Barriers for Advanced Practice Registered Nurses and Physician Assistants.)
  • The National Academies of Science, Engineering and Medicine’s nursing home report found that: “Numerous reviews have identified key outcomes resulting from APRN provided care in nursing homes, including improved management of chronic illnesses, improved functional and health status, improved quality of life, reduced or equivalent mortality and hospital admissions, improved self-care, reduced emergency department use and transfers, lower costs, increased time spent with residents, and increased resident, family, and staff satisfaction.” (National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff.)
• NPs typically complete at least six years of formal nursing education and pass national board certification prior to getting licensed and entering practice. NPs enter their graduate degree programs as registered nurses having already completed formal undergraduate Bachelor of Nursing programs, which include clinical rotations. During graduate school, NPs complete academic coursework and additional clinical rotations that prepare them to independently diagnose, manage patient care and prescribe medications and other treatments.
• NP programs are nationally accredited and the national accreditation bodies are held accountable to the U.S. Department of Education (DOE). NPs complete hands-on, supervised patient care clinical rotations that are embedded in their graduate programs and must adhere to accreditation standards. NP students must demonstrate they have integrated this prior knowledge and skill — and do not progress, or graduate, simply based on hours spent in rotation. NPs are required to pass national certification board exams and retain board certification throughout their careers.
• The authors mistake confidence for competence. It’s not unusual for some professionals in any discipline to lack confidence after graduation. For example, a recent survey by the American Academy of Pediatrics found that only 42% of pediatric residents who graduated in 2022 felt prepared for primary care practice, a significant decline from 69% in 2015.
• Citing a fringe medical group as a source, which frequently encourages the disparagement of other health care professions and engages in fear mongering in effort to restrain trade by reducing perceived competition, is reckless.
• In a Medicare Payment Advisory Commission (MedPAC) focus group, patients cited a variety of reasons for choosing an NP or physician associate (PA) as their regular primary care provider, including switching from a physician to an NP or PA as their primary care provider when their physician retired, choosing to see an NP in their practice when they had communication issues with their physician or generally preferring NPs and/or PAs to physicians.
• NPs provide a substantial portion of the high-quality, cost-effective care that communities nationwide require. According to MedPAC, APRNs and PAs comprise approximately one-third of our primary care workforce, and up to half in rural areas. NPs are essential to providing equitable access to care for all communities, including a substantial portion of health care in rural areas and areas of lower socioeconomic and health status.

Generalizations, sensationalism and cherry-picking should not be used by news sources to disparage NPs or other professions that are caring for patients and their families throughout the nation. Taking only individual negative outcomes or perceptions and then generalizing them to an entire profession that cares for patients in over a billion patient visits per year is irresponsible and dangerous. Health care collectively should rebuke this type of fear mongering by these reporters, Bloomberg News or any group seeking to advance an agenda with these despicable tactics.

Stephen A. Ferrara, DNP, FNP-BC, FAANP
AANP President

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The American Association of Nurse Practitioners^® (AANP) is the largest professional membership organization for nurse practitioners (NPs) of all specialties. It represents the interests of the more than 385,000 licensed NPs in the U.S. AANP provides legislative leadership at the local, state and national levels, advancing health policy; promoting excellence in practice, education and research; and establishing standards that best serve NPs' patients and other health care consumers. As The Voice of the Nurse Practitioner^®, AANP represents the interests of NPs as providers of high-quality, cost-effective, comprehensive, patient-centered health care. To locate an NP in your community, visit npfinder.com. For more information about NPs, visit aanp.org.