By Robert Orr



The ever-growing cost of health care in the United States is increasingly a source of strain on both individual and state budgets. Faced with these costs, an increasing number of states are reforming their scope of practice laws to allow nurse practitioners (NPs) and physician assistants (PAs) to provide a greater share of primary medical care. Granting NPs and PAs greater authority to treat and prescribe increases the supply of care providers at lower costs relative to physicians.

While significant work remains, the Medical Expenditure Panel Survey (MEPS) shows significant evidence of progress over the past couple of decades. From between 1996 and 2016, the number of office-based visits provided by NPs increased by roughly 50%.

During the same time period, the number of office-based visits provided by PAs increased by a whopping 340%, though from a much more modest starting point.

Physicians saw their share of office-based medical care decline by roughly 15% over this period. In addition to PAs and NPs, physical therapists, optometrists, chiropractors now make up a larger portion of the care-providers than in past decades.

The growing share of PAs and NPs is notable since these medical professionals often provide the sorts of care that was previously the sole domain of MDs. While PAs and NPs provide care at a lower cost per visit than doctors, this is especially true of NPs. One reason for this may be that scope-of-practice expansions for NPs are generally far more expansive than that for PAs.