Physician Wages in States with Expanded APRN Scope of Practice

Read the story behind this study in the author interview

The study shows that physician wages aren’t depressed when APRNs practice independently.

In order to increase access to primary care while reducing costs, in 2010 the Institute of Medicine recommended removing scope of practice (SOP) barriers for advanced practice registered nurses (APRNs), allowing them to practice independently of physicians.

In 16 states and the District of Columbia, APRNs now can diagnose and prescribe medications with complete or near-complete practice authority in the primary care setting. Physician associations have opposed nurses with less education being substituted for primary care physicians.

These researchers sought to determine whether expanding nursing SOP would decrease physician earnings. They compared the earnings of three types of physicians—family and general physicians, pediatricians, and surgeons—employed across states with SOP restrictions and those without. They included surgeons in their analysis because surgeons were unlikely to be impacted by expanded nursing practice laws.

Key Findings:

The average per-hour earnings of various types of physicians in states without SOP barriers, compared to those in states with SOP restrictions:

  • Family and general physicians—$79.36 per hour (without barriers), versus $81.15 (with restrictions)
  • Pediatricians—$83.94 versus $78.43
  • Surgeons—$107.23 versus $103.85

For each group, the variation in income between states with restrictive SOP laws and those with more liberal ones was not statistically significant.



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