Predictors of NPs Working Outside Primary Care

Shortages of primary care physicians have led many policy leaders to advocate for greater roles for nurse practitioners (NPs) and physician assistants, particularly in underserved rural regions. NPs are more likely to work in primary care in rural regions and contribute a notable share of the primary care services in urban areas as well. However, prior research has found that at least half of NPs do not work in primary care.  This paper examines the factors associated with NPs not being employed in primary care.

We use data from the 2012 National Sample Survey of Nurse Practitioners. This national survey provides information about NP education, demographics, and employment, including the clinical areas in which they work. We examine four different groups: (1) NPs who are not employed at all; (2) NPs who are working but not using NP credential; (3) NPs who are working in jobs that require credential but are not in patient care; and (4) NPs who are working in NP jobs that have patient care but not in primary care.  We focus on the last three groups. We analyze the data using descriptive statistics and multivariate analysis, merging onto the data regional/county-level characteristics that measure potential employment opportunities and regulatory policies that might limit NP employment.

We find that about 14% of NPs work in a position that does not require the NP credential. The NSSNP asked NPs to report the reasons they were not working in an NP position. Among those not retired, the most common responses included a lack of NP jobs in their location, a lack of NP jobs in their specialty, and inadequate compensation. Urban NPs are significantly more likely to report a lack of jobs in a desired work setting and inadequate compensation as important reasons for not working as an NP. Among those whose jobs require the NP credential, 4% are not providing any patient care. Among those employed in positions that require an NP credential, more than 25% are employed in hospital settings. Some hospital-based positions involve provision of primary care, but at least half are in emergency or inpatient care. The multivariate analysis is underway and will delve into the predictors of these employment patterns.