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The Practice Boundaries of Advanced Practice Nurses: An Economic and Legal Analysis

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  • Michael Dueker
  • Ada Jacox
  • David Kalist
  • Stephen Spurr

Abstract

The purpose of this study is to examine the effects of State regulation that determines the extent of professional independence of advanced practice nurses (APNs). We find that in States where APNs have acquired a substantial amount of professional independence, the earnings of APNs are substantially lower, and those of physicians’ assistants (PAs) are substantially higher, than in other States. These results are striking since PAs are in direct competition with APNs; the only real operational difference between these groups is that PAs are salaried employees who must work under the supervision of a physician. The implication is that physicians have responded to an increase in professional independence of APNs by hiring fewer APNs and more PAs. The finding that earnings of APNs decline when they attain more professional autonomy vis-à-vis physicians reinforces work by Sass and Nichols on physical therapists. Copyright Springer 2005

Suggested Citation

  • Michael Dueker & Ada Jacox & David Kalist & Stephen Spurr, 2005. "The Practice Boundaries of Advanced Practice Nurses: An Economic and Legal Analysis," Journal of Regulatory Economics, Springer, vol. 27(3), pages 309-330, January.
    • Handle: RePEc:kap:regeco:v:27:y:2005:i:3:p:309-330
    DOI: 10.1007/s11149-005-6626-3
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    2. Stange, Kevin, 2014. "How does provider supply and regulation influence health care markets? Evidence from nurse practitioners and physician assistants," Journal of Health Economics, Elsevier, vol. 33(C), pages 1-27.
    3. Morris M. Kleiner & Allison Marier & Kyoung Won Park & Coady Wing, 2016. "Relaxing Occupational Licensing Requirements: Analyzing Wages and Prices for a Medical Service," Journal of Law and Economics, University of Chicago Press, vol. 59(2), pages 261-291.
    4. William H. Greene & David A. Hensher, 2008. "Modeling Ordered Choices: A Primer and Recent Developments," Working Papers 08-26, New York University, Leonard N. Stern School of Business, Department of Economics.
    5. McMichael, Benjamin, 2017. "Beyond Physicians: The Effect of Licensing and Liability Laws on the Supply of Nurse Practitioners and Physician Assistants," Working Papers 07538, George Mason University, Mercatus Center.
    6. Park, Jee-Hyeong & Spurr, Stephen J. & Chang, Sheng-Kai, 2009. "A Model of Hierarchical Professionals: Cooperation and Conflict between Anesthesiologists and CRNAs," CEI Working Paper Series 2009-13, Center for Economic Institutions, Institute of Economic Research, Hitotsubashi University.
    7. Benjamin J. McMichael, 2017. "The Demand for Healthcare Regulation: The Effect of Political Spending on Occupational Licensing Laws," Southern Economic Journal, John Wiley & Sons, vol. 84(1), pages 297-316, July.
    8. Alexander, Diane & Schnell, Molly, 2019. "Just what the nurse practitioner ordered: Independent prescriptive authority and population mental health," Journal of Health Economics, Elsevier, vol. 66(C), pages 145-162.
    9. Tianyuan Luo & Cesar L. Escalante & Carmina E. Taylor, 2021. "Labor market outcomes of granting full professional independence to nurse practitioners," Journal of Regulatory Economics, Springer, vol. 60(1), pages 22-54, August.
    10. John J. Perry, 2009. "The Rise And Impact Of Nurse Practitioners And Physician Assistants On Their Own And Cross‐Occupation Incomes," Contemporary Economic Policy, Western Economic Association International, vol. 27(4), pages 491-511, October.
    11. Patricia Pittman & Benjamin Williams, 2012. "Physician Wages in States with Expanded APRN Scope of Practice," Nursing Research and Practice, Hindawi, vol. 2012, pages 1-5, February.
    12. John J. Perry, 2012. "State-Granted Practice Authority: Do Nurse Practitioners Vote with Their Feet?," Nursing Research and Practice, Hindawi, vol. 2012, pages 1-5, November.
    13. Anca M. Grecu & Lee C. Spector, 2019. "Nurse practitioner's independent prescriptive authority and opioids abuse," Health Economics, John Wiley & Sons, Ltd., vol. 28(10), pages 1220-1225, October.

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