Scope of practice and NP mobility serving Medicare beneficiaries
Publication id: shakya-2020-np-sop-medicare-mobility
Status: verified
Citation: Shakya, S., & Plemmons, A. (2020). Does scope of practice affect mobility of nurse practitioners serving Medicare beneficiaries? Journal of Labor Research. Download PDF
Facts¶
Policy hook¶
Nurse practitioner shortages limit healthcare access and increase costs, particularly in primary care and rural areas. Some states have expanded scope-of-practice laws to give nurse practitioners greater autonomy (full practice authority and independent prescribing rights). A key question is whether expanded scope-of-practice laws incentivize NP relocation or retention within a state, improving workforce distribution.
Main finding¶
Nurse practitioners in full-practice-authority states are 0.41 percentage points less likely to move out of state compared to NPs in restrictive-practice states. Among NPs who do relocate, those considering moves are 5.70 percentage points more likely to choose full-practice-authority states over restrictive-practice states as their destination. The effects suggest that scope of practice is a meaningful factor in NP location decisions, though the magnitude of effect is modest.
Data and setting¶
Medicare Part D Prescriber Public Use Files matched with National Provider Identifiers, covering NPs serving Medicare beneficiaries during 2013–2017. States were categorized as “full-practice” (NPs can order testing, prescribe medications, and diagnose independently without physician oversight) versus “restricted/reduced-practice” (requiring physician supervision or collaboration for some tasks). NP location and moves were tracked across years using NPI registry data.
Research design (plain language)¶
The paper analyzes individual nurse practitioners’ location decisions across states with different scope-of-practice regimes. Regression analysis examines the probability of out-of-state moves for NPs practicing in each state type. A second analysis compares the destination-state choices of relocating NPs, testing whether they preferentially choose full-practice versus restricted-practice states. The design controls for state economic and demographic characteristics that might influence NP location independent of scope of practice.
One caveat¶
Percentage changes are modest (0.41%, 5.70%), suggesting that scope of practice is one factor among many influencing NP mobility decisions. The analysis is limited to Medicare prescription drug program data, which captures only NPs with Medicare prescriber identities; it does not reflect all NP practice activity or patient populations. The design cannot determine whether NPs are moving to practice more autonomously or for other reasons (family, cost of living, etc.) that correlate with scope-of-practice permissiveness.
PDF or DOI¶
Why it matters¶
Scope-of-practice restrictions are a long-standing barrier to NP practice in the United States. Policymakers considering scope expansions often argue that broader autonomy will attract and retain NPs, improving workforce supply in underserved areas. This paper provides empirical evidence that expanded scope of practice does influence NP location choices—practitioners are more likely to relocate to full-practice states and less likely to leave them. The effects are statistically significant but modest in magnitude, implying that scope of practice is a meaningful but not dominant factor in NP mobility decisions. For states considering scope expansion as a workforce strategy, the findings are supportive: removal of restrictive oversight rules does make the state more attractive to NPs. However, the modest effects suggest that scope expansion works best alongside complementary policies—loan forgiveness, rural incentives, educational pipeline development—to meaningfully shift NP distribution toward shortage areas. The results also highlight the importance of understanding profession-specific regulations as labor market institutions that shape worker location decisions.