Insights From Wapiti

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The growing numbers of Nurse Practitioners in rural areas can fill the gaps created by the ongoing physician shortage. The NP profession continues to grow rapidly, with nearly half of all rural primary care practices employing at least one NP.

A recent article from the National Rural Health Association (NRHA) discusses a study on NP autonomy. The study, conducted by Hannah Neprash, PhD, (Assistant Professor at the University of Minnesota Division of Health Policy and Management) was done in collaboration with several NRHA members within the University of Minnesota Rural Health Research Center.

In the study, NP autonomy was measured by reviewing three facets of independence:

  • The percentage of patients who are treated exclusively by NPs (rather than physicians)
  • The independence of NPs from physician supervision (measured in terms of how services were billed)
  • The authority of NPs to prescribe a range of medications including controlled substances


Data from 2,590 primary care practices was reviewed. Although rural and urban NPs provided similarly complex care, rural NPs appear to have more freedom with decision-making as shown in the results below:

  • In rural practices, 10.8% more patients were seen exclusively by NPs compared to their urban counterparts.
  • Rural NPs were 14.9 to 34.8% more likely to practice without direct supervision from physicians than urban NPs.
  • Rural NPs were 9.6% more likely to prescribe Schedule II controlled substances, such as opioids, compared with urban NPs.


As the role of NP expands in underserved rural areas, the findings of this study support the need for education and training to prepare NPs for the demands of rural practice.