Nurse practitioners key to increasing health care access in less advantaged areas, study shows

Primary care practices that employ nurse practitioners (NPs) are more likely to serve socioeconomically disadvantaged communities than practices with no NPs on staff, Columbia University School of Nursing researchers report in JAMA Network Open. Assistant Professor Monica O’Reilly-Jacob, Ph.D., led the study, published online February 28, 2025.

To better understand the distribution of NPs—who are increasingly critical to improving access to primary care—O’Reilly-Jacob and her colleagues looked at 79,743 primary care practices across the U.S., 53.4% of which employed NPs in 2023. The authors note that this is a big jump from 2012, when 21% of primary care practices employed NPs.

Practices with NPs were more likely to be based in low-income (23.3% vs. 17.2%) and rural (11.9% vs. 5.5%) areas, the researchers found. Communities where primary care practices employed NPs had more people living below the poverty level (14.4% vs. 12.8%) and more people without high school diplomas (19.8% vs. 18.5%).

“This study demonstrates that NPs are increasingly utilized for primary care delivery across the country, and especially within low-socioeconomic communities,” O’Reilly-Jacob and her colleagues note. “This is important as fewer medical residents are choosing to practice primary care, resulting in an estimated shortfall of 20,200-40,400 primary care physicians by 2036.”

Policies are also needed to bring NPs to underserved areas, and retain them, the researchers add, “such as strengthening federal and state loan repayment programs, establishing pay parity in state Medicaid programs, and ensuring primary care provider designation for NPs across payers. Such steps would expand the capacity of the primary care system to better meet demand in communities where it is needed most.”