NPs key to better rural care

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National Nurse Practitioners (NP) Week concludes today and never have NPs been more important to providing rural health care.

Rural family nurse practitioners provide vital services to underserved populations that have inadequate access to resources. RNs who become FNPs through online master's in nursing programs work on the front lines of the battle against chronic illnesses that have crippled generations of families.

For city dwellers, rural life can seem like an entirely different world. The pace of life slows down. Neighbors all know each other. Local grocers and family-run businesses replace big-box stores and chain restaurants. The American ideal of small-town life is picturesque, but it is the type of lifestyle that many young people have a hard time envisioning for themselves.

Only about 20 percent of physicians working in rural areas are under 40 years old — and 30 percent are rapidly approaching (or have already passed) retirement age. Due to an aging population and a lack of experienced and trained professionals, there is increasing demand for healthcare professionals in rural areas, leading to a significant opportunity for nurse practitioners to pick up the slack.

According to a study by the University of Michigan, the demand for physicians in rural areas is being filled by nurse practitioners. It is a well-established that physicians, physician assistants, and chiropractors are concentrated in the most affluent areas with already high life expectancies. Another report found nurse practitioners may opt for practice in rural and lower-income areas with low life expectancy, following the need rather than the money.

Aging baby boomers are snowballing into the largest patient population in history, and while their health care needs spike, the number of physicians practicing is falling nearly as quickly. The net result is a provider population simply not big enough — or geographically dispersed enough — to handle mounting patient demand.

By 2030, experts project the shortfall to reach more than 120,000 providers — but the access to care, or lack of it — will not be distributed evenly. Some communities will have less provider choice and longer wait times. Other, smaller communities will have an even bigger problem — no access at all. Patients living in rural communities are five times more likely to live in a shortage area than patients living in urban or suburban areas. With more than 270,000 NPs practicing, and roughly 30,000 new NPs entering the health care workforce every year, NPs are adding high-quality health care providers and critical mass to our health care workforce. NPs are trained to evaluate and diagnose patients, order and interpret diagnostic tests and prescribe medications in all 50 states. More than 85 percent of NPs are trained in primary care — the biggest shortage area in rural communities.

While physicians are likely to be concentrated in urban areas, NPs are more likely to settle in rural areas. NPs represent one in four providers in rural practices, and more in states with full practice authority laws. Modernization of scope of practice legislation would decrease the number of patients living in a rural primary care shortage area from 23 million to 8 million.

Because most rural nurse practitioners work with a family practice certification, the patient population they treat can run the gamut. Due to the high demand for healthcare professionals in rural areas and consequent lack of specialists, NPs can expect to see and treat pregnant women, infants, adults, and senior citizens.

While the exact daily responsibilities will vary according to the type of clinic or office where an NP works, most rural NPs can perform a wide range of tasks.

President Trump recently signed a Medicare executive order, calling for, among other things, reforms that allow NPs to practice at the top of their profession and removing artificial restraints that still exist in more than half the states that have yet to pass full practice authority legislation. Research shows states with limited practice rights have 40 percent fewer NPs practicing — sweeping reform would pave the way for an influx of NP providers, especially in rural and underserved areas where seniors will otherwise struggle to find care.

Meanwhile, NPs are embracing seniors with open arms. Nearly 90 percent of NPs see patients over the age of 66 and more than 80 percent are accepting new Medicare patients. As we approach 2030 and baby boomers finally begin to reach the golden age of 66, there is no provider army more prepared than NPs. The number of new NPs outpaces physicians, and two-thirds of the practitioners added to the workforce between now and 2030 will be advanced practice clinicians like NPs.

Despite lingering provider shortages, nearly 90 percent of NPs will be prepared in primary care and ready to treat baby boomers into their sunset.

NPs have graduate level, advanced education and clinical training beyond their registered nurse preparation. An NP practice offers a unique combination of nursing and healthcare service to patients. Focusing not only on diagnosing and managing acute and chronic illnesses, NPs integrate health promotion, disease prevention, counseling and patient education to help patients understand their complete health picture.