Working Paper: NBER ID: w31109
Authors: Sara Markowitz; Andrew JD Smith
Abstract: Many states have recently changed their scope of practice laws and granted full practice authority to nurse practitioners, allowing them to practice without oversight from physicians. Physician groups have argued against this change, citing patient safety concerns. In this paper, we use a ratio-in-ratio approach to evaluate whether the transition to full practice authority results in harm to patients as proxied by rates of malpractice payouts and adverse action reports against nurse practitioners. We find no evidence of such harm, and instead find that physicians may benefit from the law change in terms of reduced malpractice payouts against them.
Keywords: Nurse Practitioners; Scope of Practice; Malpractice; Patient Safety
JEL Codes: I1; K1
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Transitioning to FPA (O24) | Patient safety is not compromised by the removal of physician oversight (I11) |
| No significant changes in adverse actions taken against NPs related to safety violations post-FPA (I19) | Patient harm is not evident following the policy change (I18) |
| Decrease in malpractice payouts against physicians (I11) | Removal of supervisory relationships may benefit physicians by reducing their liability (I11) |