BUSI 429 Week 3 Discussion Board Forum 3 Example

Discussion Board Forum 3: Health Workforce Supply and Practice Regulation

BUSI 429 Healthcare Economics, Discussion Board Forum 3

Thread by [Student Name]

The state, its debate and the classmates are composites; the textbook, Scripture and the peer-reviewed sources cited are real.

Our state legislature is again debating a bill that would let nurse practitioners practice and prescribe without a supervising physician agreement, a status known as full practice authority. The state medical society opposes the bill on quality grounds, and the nursing association supports it as a way to expand access in counties with too few primary care physicians. As someone who works in a rural clinic network that cannot fill two physician openings, I see this as an economic question about supply. Patients in two of our counties now wait more than five weeks for a new primary care appointment, and many give up and use the emergency department instead.

Feldstein (2015) explains that licensing and scope-of-practice laws restrict the supply of services by limiting who may provide them. Restrictions can protect quality, but they also reduce competition, raise the incomes of those already licensed and make care more expensive and harder to reach. Feldstein encourages students to ask who benefits from such rules, and in this case the groups lobbying hardest have direct economic interests on both sides.

The evidence on full practice authority is now substantial. McMichael (2025) studied 22 states from 2010 to 2019 and reported that once states let nurse practitioners practice independently, preventable admissions for diabetes and similar chronic illnesses declined, the kind of hospital stays that timely office care is meant to head off. The effects were especially consistent among privately insured patients. Fitzpatrick et al. (2026) drew on two decades of a federal household survey and reported that after reform, nurse practitioners delivered somewhat more primary care visits while physician visits held steady, along with fewer nonurgent emergency department visits. In economic terms, expanding supply increased the total amount of primary care rather than simply shifting patients from one provider to another.

The strongest objection is quality, and it deserves a serious answer rather than dismissal. The studies above measured outcomes such as avoidable hospitalizations and found improvement rather than harm, but a state that adopts reform should still monitor outcomes and require transition-to-practice hours for new nurse practitioners. Every rule about who may provide care is also a rule about how much care there will be. On balance, the evidence favors passing the bill. Jesus observed that the harvest is plentiful but the laborers are few (English Standard Version Bible, 2001/2016, Matthew 9:37), and in a county with unfilled positions and long waits, rules that keep qualified laborers from the field deserve hard scrutiny.

Reply to Carmen

Carmen, you worried that removing physician supervision could lower the quality of care, especially for complex patients. That is the most important objection to full practice authority, and it deserves evidence rather than assumption from either side of the debate. Pitts and Lindley (2026) reviewed 13 studies on the effects of nurse practitioner practice regulation and concluded that, at a minimum, full practice authority did not worsen health outcomes and that it was associated with better provider-to-patient ratios and with nurse practitioners moving to and staying in states that granted it. McMichael (2025) found fewer avoidable hospitalizations for chronic conditions after states granted full practice authority, which suggests that more access to outpatient care improved results for exactly the kind of patients you describe. Feldstein (2015) cautions that quality arguments are sometimes used to protect incomes, so it helps to ask whether the outcomes data support the concern. That said, monitoring is still wise. A state could require new nurse practitioners to complete a set number of supervised hours before practicing independently and could track outcomes such as avoidable admissions by county after the law changes. Would that kind of safeguard address your concern while still expanding the supply of primary care in places that need it? It would also give legislators real data to revisit the law after a few years, instead of relying on the predictions of the groups with the most at stake. A sunset review, in which the law expires unless renewed after outcomes are examined, is one way some states have built that accountability into reform.

Reply to Henry

Henry, you asked whether full practice authority actually helps rural areas or whether nurse practitioners simply settle in cities like physicians do. The answer matters, since rural access is one of the main arguments for reform, and a policy that only adds providers in suburbs would do little for the counties that need help most. Pitts and Lindley (2026) found that full practice authority was associated with nurse practitioners migrating to and remaining in states that adopted it, which suggests the policy changes where providers choose to work. Fitzpatrick et al. (2026) found that nonurgent emergency department use fell in states that granted full practice authority, a sign that people found primary care elsewhere, which is especially important in rural counties where the emergency department may be the only option after hours. Feldstein (2015) explains that removing barriers to supply makes it more attractive for providers to practice where demand is unmet, but he also notes that other factors, such as income and amenities, still shape location choices. A state could strengthen the rural effect by pairing reform with loan repayment for nurse practitioners who work in shortage areas, a targeted incentive that costs far less than recruiting physicians. Does your clinic network already use nurse practitioners in any rural sites? Their experience could show whether supervision requirements, rather than interest, have been the main barrier to expanding care there. In some rural areas the required supervising physician lives hours away, which adds cost and paperwork without adding much oversight, and removing that requirement may matter more than any recruitment incentive.

References

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Feldstein, P. J. (2015). Health policy issues: An economic perspective (6th ed.). Health Administration Press.

Fitzpatrick, J. J., Duffy, E. G., Mehlman, M., Votruba, M., Gerlick, J. A., Dower, C. M., Davis, S., Plemmons, A., & Norful, A. A. (2026). Variations in nurse practitioner full practice authority in the United States: Difference in difference analysis of access and health performance at a national level. Health Policy OPEN, 10, 100167. https://doi.org/10.1016/j.hpopen.2026.100167

McMichael, B. J. (2025). The impact of nurse practitioner scope-of-practice laws on preventable hospitalizations. Journal of Health Economics, 103, 103044. https://doi.org/10.1016/j.jhealeco.2025.103044

Pitts, C. J., & Lindley, L. C. (2026). The impact of nurse practitioner state practice regulation on health and health outcomes: An integrative review. Journal of the American Association of Nurse Practitioners, 38(7), 487-495. https://doi.org/10.1097/JXX.0000000000001264