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The Effects of State Scope of Practice Laws on the Labor Supply of Advanced Practice Registered Nurses

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  • Sara Markowitz
  • E. Kathleen Adams

Abstract

This paper studies the effects of changes in states’ scope of practice (SOP) laws for advanced practice registered nurses (APRNs) on individual labor supply decisions. Restrictive SOP impose costs and other barriers to practice that may affect these decisions. Using survey data on APRNs, we analyze employment in nursing, work hours, part-time work status, multiple job holding, self-employment, wages, and migration. Results show that the level of SOP restrictions are not strong determinants of many labor market decisions but APRNs working in states without oversight requirements are much more likely to be self-employed and to work more hours. APRNs are also found to commute to less restrictive SOP environments when geographically feasible. Increases in the labor supply of nurses when regulatory environments are relatively free from physician oversight requirements can bring an important change to the delivery of health care in the United States.

Suggested Citation

  • Sara Markowitz & E. Kathleen Adams, 2022. "The Effects of State Scope of Practice Laws on the Labor Supply of Advanced Practice Registered Nurses," American Journal of Health Economics, University of Chicago Press, vol. 8(1), pages 65-98.
    • Handle: RePEc:ucp:amjhec:doi:10.1086/716545
    DOI: 10.1086/716545
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    Cited by:

    1. Shishir Shakya & Joshua K. Bedi & Alicia Plemmons, 2024. "Healthcare Workforce Shortages and Job Autonomy: Nurse Practitioners and Entrepreneurship in the United States," Working Papers 24-08, Department of Economics, Appalachian State University.
    2. McNamara, Cici & Pineda-Torres, Mayra, 2024. "Medical Residency Subsidies and Physician Shortages," IZA Discussion Papers 17263, IZA Network @ LISER.
    3. Hoehn-Velasco, Lauren & Huang, Yu-Ting & Yusuff, Olanrewaju, 2025. "Public Payment Mandates and Provider Supply," IZA Discussion Papers 18149, IZA Network @ LISER.
    4. Sara Markowitz & Andrew J. D. Smith, 2024. "Nurse practitioner scope of practice and patient harm: Evidence from medical malpractice payouts and adverse action reports," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 43(2), pages 420-445, March.
    5. Noah J. Trudeau, 2021. "Occupational Licensing and Intra-MSA Effects: Massage Therapists in the US," Working Papers 21-03, Department of Economics, West Virginia University.
    6. McNamara, Cici & Pineda-Torres, Mayra, 2025. "Medical residency subsidies and physician shortages," Journal of Public Economics, Elsevier, vol. 251(C).
    7. Moiz Bhai & David T. Mitchell, 2024. "The effects of occupational licensing reform for nurse practitioners on children's health," Southern Economic Journal, John Wiley & Sons, vol. 91(1), pages 62-91, July.
    8. Shishir Shakya & Alicia Plemmons, 2020. "Does Scope of Practice Affect Mobility of Nurse Practitioners Serving Medicare Beneficiaries?," Journal of Labor Research, Springer, vol. 41(4), pages 421-434, December.
    9. McMichael, Benjamin J., 2025. "The impact of nurse practitioner scope-of-practice laws on preventable hospitalizations," Journal of Health Economics, Elsevier, vol. 103(C).
    10. Pinka Chatterji & Chun-Yu Ho & Xue Wu, 2023. "Obstetric Unit Closures and Racial/Ethnic Disparity in Health," NBER Working Papers 30986, National Bureau of Economic Research, Inc.
    11. Moiz Bhai, 2025. "The effect of Certificate‐of‐Need laws on physician earnings and labor supply," Southern Economic Journal, John Wiley & Sons, vol. 92(1), pages 152-175, July.
    12. Chen, Alice J. & Munnich, Elizabeth L. & Parente, Stephen T. & Richards, Michael R., 2023. "Provider turf wars and Medicare payment rules," Journal of Public Economics, Elsevier, vol. 218(C).
    13. Hoehn-Velasco, Lauren & Jolles, Diana R. & Plemmons, Alicia & Silverio-Murillo, Adan, 2023. "Health outcomes and provider choice under full practice authority for certified nurse-midwives," Journal of Health Economics, Elsevier, vol. 92(C).

    More about this item

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • J01 - Labor and Demographic Economics - - General - - - Labor Economics: General
    • K0 - Law and Economics - - General

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