Nurse Practitioners and Obamacare: How Will Health Reform Affect Nurse Practitioners?

Two things are certain about health reform:  health reform is controversial and health reform will positively affect the nurse practitioner job market.  With the passage of the Affordable Care Act, nearly 50 million Americans will gain access to healthcare services.  Given the current shortage of primary care physicians, nurse practitioners must be ready to step in and fill in the gap to provide healthcare services to these newly insured patients.

Many Americans have been unable to receive health insurance in the past due to financial constraints or lapses in coverage due to preexisting conditions.  The Affordable Care Act promises to remove these barriers for 50 million Americans allowing them to gain coverage under a health insurance plan.  This influx of new patients into the healthcare system promises to strain the current primary care provider shortage in the U.S.  Teresa Valero of the Mennonite College of Nursing predicts the shortage of primary care providers will be overwhelming stating “the problem is that the number of physicians who choose primary care are decreasing”.  Given the primary care shortage, how will 50 million people find healthcare providers?

Nurse Practitioners are the answer to this problem.  Nurse practitioners are able to provide quality primary care services to patients.  In many states, NP’s are allowed to practice independently without physician supervision making them even more effective in filling the primary care gap.  Nurse practitioners can also complete their schooling much more quickly than physicians allowing universities to quickly educate students so they can step in to help this problem.  NP’s are the obvious solution to the primary care shortage in the U.S.

If you are considering becoming a nurse practitioner, start now!  With 50 million new Americans soon to be flooding clinics across the nation, we need you!  If you are already a nurse practitioner, Obamacare is good news for you as well.  As demand for nurse practitioners increases, the job market improves with new NP positions opening.  Nurse practitioner salaries will increase as nurse practitioners are increasingly viewed as the solution to the primary care physician shortage.  Bottom-line?  Is you are an NP, health reform is good news.

22 thoughts on “Nurse Practitioners and Obamacare: How Will Health Reform Affect Nurse Practitioners?”

  1. George Kiongera, NP

    I can’t wait the day NPs will have the independence of practicing without physician supervision. It is ridiculous and insulting to do all the work and have a physician scrible some inelligible signature next to an NP signature in the name of supervision.

  2. In NC the requirements to practice as a NP is changing. In 2015 NP’s will need a doctorate to practice.

    I think there may be a shortage in NC! I am planning to go back for a post Master’s Certificate in FNP. I think I should be finished by 2015 so I can be grandfathered in.

  3. Good plan! It would be ideal to finish your program by 2015 so you will still be able to practice with a Master’s degree.


    I am the owner of the (possibly) first pediatric office in NJ owned by an NP. we opened in November. Check it out.

  5. So with your range of experience as an RN and then doing a 2 year MSN or DNP (without complex pathophysiology of medical school + residency + a basic sciences undergraduate degree) you feel you can practice independently? even if you diagnosed 80-90 percent of what a physician does, you still can’t tell me how a medication works at the cellular level. Is that 55 year old guys back pain just MSK strain? is it a monoclonal gammopathy of undetermined significance? is it an infection? The problem a lot of us have is we recognize how much we dont know. Some MLP believe that medicine can be simplified, it just isnt.

  6. Actually, I have an undergraduate degree packed with science courses.  I majored in Molecular and Cellular Biology and Minored in Chemistry…all while graduating a year early from a well regarded University.  I do understand how the body and medications work at a cellular and molecular level.  And, when I don’t my background provides me the ability to read a recent research article or scientific publication to figure it out.  Most importantly, I am smart enough to know when I have a question or problem.  If a diagnosis or presentation of symptoms isn’t adding up I consult a physician, or refer the patient for a higher level of care.  Although some may think referring a patient negates “practicing independently”, physicians do it all the time.  When a family practice physician cannot control a patient’s diabetes, for example he or she refers to endocrinology.  No, medicine isn’t simple.  Fortunately though providers work on a continuum.  When a patient falls out of one provider’s level of expertise, they are referred on for more specialized care.

  7. Thank you, Erin. These incessant rants regarding the lack of “scientific” education possessed by nurse practitioners never fail to infuriate me. I realize that physicians are required to attend medical school, but it is not “magic” school. Physiology is the basis of life and, yes doc, we had to take it. Pharmacology is the study of the action of substances upon molecules which activate or inhibit bodily processes–I took that one too. We also read the books that we bought for the classes that we paid top dollar for in order to pass the tests, in turn graduating from accredited institutions of higher learning. Oh yes, we also passed national certification exams. So, doc, there is no magic to medicine–just study and mastery. Don’t go getting your wizard hat in a knot.

  8. I am so disgusted by the lack of respect the nursing profession gets from others in our society and other physicians. It is partly our fault and partly that of others. However, enough is enough!!! To reply to “doc’s” comment “without complex pathophysiology of medical school + residency + a basic sciences undergraduate degree” All US accredited NP educational institutions require an Advanced level of Pathophysiology, Pharmacology. They also require many hours of a diverse rotation schedule and many other classes before you are even allowed to sit for the State certification exam. Also, not to mention the countless science specific classes I had to take even for my undergrad. Eg. Anatomy & Physiology I & II lec and lab and Physics I & II lec. and lab Organic Chem I & II lec and lab the list goes on & on…
    The real problem is that physicians feel themselves so superior to other healthcare professionals not just NPs that even the thought of others being able to function without them or their approval makes them feel quite inadequate and very insecure. Well guess what “doc” tough luck, deal with it, NPs are here to stay!!
    Bottom Line: There is a very real shortage of primary care providers and many hard working and very intelligent Nurse Practitioners have stepped up to assist in providing healthcare to those who may usually not have the privilege or access to it. So “doc” go gripe to someone who actually cares while you are working on your second or third divorce and paying back the $100k+ you owe in school loans.

  9. I agree that the MD degree probably prepares them to diagnose and treat medical illness better than the NP educational path…but I have just a few questions. If the MD degree is so superior, and their training puts MD’s at such a high level of understanding and medical knowledge, why does the U.S. spend more on healthcare than any nation in the world? Why do we have such a staggering and increasing amount of extremely unhealthy Americans? Why is the quality of our care so low? And why do we have such poor health outcomes, as compared with other countries in the world? Maybe MDs need some help?

  10. So according to the genius MD that chimed in, they can do no wrong and NP’s and RN’s, RT’s don’t know how to diagnose as well as them… huh, is that why we have to make sure you don’t kill the patients when you write orders incorrectly? I would like to point out that every NP has to actually WORK as a RN first before they can practice in their specific field. When was the last time you saw a MD work as a bedside tech, nurse… anything? Now there are those special examples out there and there are some very intelligent and respected physicians that I would trust my daughter to, the person above is not one of them. Anyone that egotistical wouldn’t be able to ask for help when in over their head! I always tell our new residents, if you want to survive, please, just listen to the staff around you… this isn’t their first day but it is yours! And just for the record, Albuterol only works on smooth muscle in the lungs… it doesn’t cure everything or it would be called All-better-all! June is the most dangerous time in healthcare… beware of the MD’s with the fresh long coat!

  11. Devin,

    The reason we spend more than any other nation in the world on healthcare is complex. But the simple answer is that we have a “disease management system,” where healthcare providers are paid by the number of patients they see and procedures they do, rather than a system in which providers are paid for “health improvement outcomes.” If a system paid for demonstrated improved health, that would be a great improvement to our current system. See the 2012 documentary “Escape Fire: The Fight to Rescue American Healthcare” for a good overview of the problem and potential solutions. I really enjoyed this film and play it for the students in my advanced practice nursing classes.

  12. Hi Erin,
    I will be starting an accelerated BS/MS FNP program in the Fall 2013 and will graduate in Spring 2016. Does that mean I have to continue on with the DNP studies in order to practice as an FNP? Thanks.

  13. I will go for my NP when the paradigm from which we operate changes from a symptom management society to a prevention, keeping people well way of practicing. I like the idea of having both Physicians and NP’s. I think Nurses have a lot to offer Doctors and vice versa. Let’s be friends and change healthcare in America together. Seriously.

  14. I am currently enrolled in a part time ANP program, but I will not be finished until 2016. I plan to go on for a post masters FNP after, will I be grandfathered in under the MSN?

    Thank you

  15. Hi Erin, your site is so helpful! I am an RN in home health in NC and could greatly benefit patients with more autonomy that a NP degree would offer, but sadly only recently became aware of the new DNP rule. I have an ADN with a BS in Business, so I have at least a year to complete a BSN. You would think they would relax that rule considering the demand for more NP’s?

  16. Hi Stephanie,

    Fortunately, most experts don’t think the DNP rule will take effect by 2015.  They predict it will be much longer before the DNP is actually required so you likely have time to start an NP program before it is required.  So yes, I think the DNP regulation will be delayed. 

  17. I can not help to think of all the patients that have had near misses when the PHYSICIANS overlooked what our supposedly “minimal” background in pathophysiology caught! No further comment.

  18. The reimbursement will not got UP, it will go down. Medicare is already 15% less than an MD. An independent NP has to have a sig from an MD f0r hospice, home health and nursing homes. Trust me if you are independent, you’re tanked. Obamacare is raising $$$$$ for primary care MD’s. Great, if you want another seven or so years of training. I already have 13. Read today’s CNN Money. You might want to be near a toilet.

  19. I cannot help but hope that NP’s are governed more authority in the healthcare arena. I have heard of a new law being looked at that NP’s will be able to practice without a sig from a MD for hospice, home health, and skilled nursing. I am an independent practitioner that is the only NP in my city providing house calls to many unfortunate elderly individuals that are unable to leave their homes. I do have an MD sign my skilled nursing but its a sig and is unknown to many of my patients. As far as physiology, pharmacology, and practice…many MD’s I practice along are amazed on how much education and interns we have! It is the stubborn and egotistical MD that doesn’t want to work alongside and understand why we are a NP. Many patients tell me that I treat the entire problem and come to the core of what is wrong vs. physician telling them to make another appointment and refer for simple matters as they are too busy to deal with during the appt. Maybe “doc” should listen and learn from NP’s…see what we do and work with us not against! Modern medicine is allowing MD’s to specialize in the medical model! I believe in “Providing the Best Care Possible”…not concentrating on who provides the better care! Move on Doc…

  20. I am a RN with many years of Flight Nursing, ICU, and ER experience. I have had many experiences with MD’s who cannot admit mistakes, take sound medical advice, or be thankful for help in avoiding a medical disaster from someone they feel is INFERIOR. I have rarely had this same experience when working with nurses and nurse practitioners. I currently work in an ICU in a teaching hospital. I have heard attending physicians tell resident physicians that they are treating a patient correctly even when medical errors are made. For example giving adenosine for wide complex tachycardia. Then following up with amiodarone, metoprolol , and cardiazem! I guess to cover all possible tachy arrhythmias. What a joke. This type of incident occurs to frequently . Disdain for nursing, respiratory, and other staff begins in residency . Residency should be an opportunity to train compassionate, competent, and integrated providers. Not a program to further inflate egos. The reality is that no single person can know everything about medicine. Medical professionals should be life long learners and collaborators. Our patients deserve it. Looking forward to starting a DNP program in 2014. Thanks.

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