title: Practice characteristics of primary care nurse practitioners and physicians.
abstract: BACKGROUND
  Projections of physician shortages, an aging population, and insurance expansions have increased interest in expanding the number of primary care nurse practitioners (PCNPs) in the United States. Although information about the number and distribution of nurse practitioners is known, there is little information about the practice characteristics of PCNPs. The purpose of this study was to identify demographic and practice characteristics of PCNPs and compare these characteristics with primary care physicians (PCMDs).
  
  
  METHODS
  From November 23, 2011, to April 9, 2012, we conducted a national postal mail survey of 972 clinicians (467 PCNPs and 505 PCMDs). Questionnaire domains included compensation and billing practices; characteristics of patients treated; PCNPs' use of their own National Provider Identification number to bill services; how PCNPs spend their time; clinical and nonclinical activities performed; and whether PCNPs have privileges to admit, round on (i.e., oversee the care provided to) patients, and write orders independently of physicians. The response rate was 61.2%.
  
  
  CONCLUSIONS
  PCNPs are more likely than PCMDs to practice in urban and rural areas, provide care in a wider range of community settings, and treat Medicaid recipients and other vulnerable populations. Not only do most PCNPs work with PCMDs, but also the majority of both clinicians believe that increasing the supply of PCNPs will result in greater collaboration and team practice. Although PCNPs and PCMDs deliver similar services and spend their time in nearly identical ways, PCNPs work less hours and see fewer patients, and only a handful of PCNPs have their salary adjusted for productivity and quality performance. PCNPs cite government and local regulations as impeding their capacity to admit and round on patients in hospitals and long-term care facilities and write treatment orders without a physician cosignature.
  
  
  CONCLUSIONS
  Significant differences in demographic and practice characteristics exist between PCNPs and PCMDs. Whether working independently or with PCMDs, increasing the number of PCNPs can be expected to expand access to primary care, particularly for vulnerable populations, and for those gaining access to health insurance through the Affordable Care Act.
authors.affiliation: Department of Health Policy, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN. Electronic address: peter.buerhaus@vanderbilt.edu.
authors.forename: Peter I
authors.initials: PI
authors.lastname: Buerhaus
authors.affiliation: Mathematica Policy Research, Cambridge, MA.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: DesRoches
authors.affiliation: Institute for Medicine and Public Health, Nashville, TN; Geriatric Research, Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN.
authors.forename: Robert
authors.initials: R
authors.lastname: Dittus
authors.affiliation: Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA.
authors.forename: Karen
authors.initials: K
authors.lastname: Donelan
mesh_terms: D000328:Adult; D002321:Career Choice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D020399:Practice Management / Q000458:organization & administration*; D057184:Practice Patterns, Nurses' / Q000458:organization & administration*; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D011365:Professional Practice Location; D011795:Surveys and Questionnaires; D014481:United States
keywords: Nurse practitioner practice characteristics; Primary care; Primary care nurse practitioners