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Rural Areas In Pennsylvania Among Those Using Nurse Practitioners (NPs) To Fill The Void In Primary Care Providers

Washington, Pennsylvania, is a small rural community with many residents struggling financially. The town lacks local medical providers; therefore, many travel roughly 30 miles towards Pittsburgh for care. Joyce Knestrick, a Washington native, pursued her education to be a Nurse Practitioner (NP) largely to assist towns lacking an adequate number of primary care health providers. She now leads the American Association of Nurse Practitioners (AANP) and advocates for changes to care accessibility.

NP Autonomy & Scope of Practice

A large problem that NPs face when filling the primary care void is their limited scope of practice in many states. They want to be able to evaluate, diagnose, interpret test results, and prescribe medication; however, they are not medical doctors. At least 16 states have some restrictions for them regarding practice, while another 12 require that NPs are regularly supervised by a physician. NPs feel they are qualified and would like to see such limitations eliminated.

Demand for Nurse Practitioners

Simon Murray, MD, a professor of medicine at Rutgers, explains that 70% of doctors in most countries work in primary care rather than in specialties, while the numbers in the U.S. are the exact opposite, leading to the shortage.

American Association of Medical Colleges data shows that by 2030 the U.S. will have a shortage of just over 100,000 physicians–over half in primary care. NPs are increasingly entering the field and there are approximately 234,000 in the current workforce. NPs may be used as a valuable resource for patient care that can afford physicians additional time to focus on complex medical conditions.

Increasing Risk for Malpractice Claims

NPs have been the named defendant in approximately 2% of medical malpractice claims. NPs will increasingly be exposed to a higher likelihood of claims of malpractice as their scope continues to broaden. The CNA and Nurses Service Organization revealed the following data regarding NP claims of malpractice.

  • Failures in diagnosis or untimely diagnosis were alleged in 43% of claims.
  • Improper treatment was cited in 29.5% of claims.
  • Medication-related errors were associated with 16.5% of claims.

Factors Influencing Likelihood of NP Malpractice Claims

NPs are striving to continue their low rates of medical malpractice claims by maintaining professional standards, empathy, consideration, and respect for patients and their families. There are certain factors that increase the likelihood of facing a claim of malpractice, including seeing over 16 patients per day, treating the elderly, and those working in outpatient care. Surprisingly, the ability to prescribe medications has yet to influence the rates of malpractice claims.

Future of NPs in Primary Care

Joyce Knestrick says NP training and education make them a great fit for filling in gaps of care within primary care. She finds most physicians to be “generally supportive” of NPs in the realm of primary care, yet acknowledges that much of organized and traditional medical organizations remain hesitant toward their expanding role. She feels the progression toward individualized models of care is conducive to NP involvement.

About the Author

Briggs Bedigian
Briggs Bedigian

H. Briggs Bedigian (“Briggs”) is a founding partner of Gilman & Bedigian, LLC.  Prior to forming Gilman & Bedigian, LLC, Briggs was a partner at Wais, Vogelstein and Bedigian, LLC, where he was the head of the firm’s litigation practice.  Briggs’ legal practice is focused on representing clients involved in medical malpractice and catastrophic personal injury cases. 


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