Southern States Could Benefit from Using More Nurse Practitioners, Certified Nurse-Midwives and Physician Assistants

Educating Southern policy-makers about the use of nurse practitioners

The southern states have the highest proportion of citizens living in areas that have a shortage of health professionals. Evidence suggests that certified nurse-midwives, nurse practitioners, and physician assistants can provide high-quality, cost-effective care, but their use is limited in the South.

From 1994 to 1997, the Council of State Governments, Lexington, Ky, conducted a survey of more than 800 key stakeholders to document barriers to practice for these health professionals in the South.

It also assembled a state-by-state "snapshot" detailing the specific numbers of these practitioners in each state, the educational and training resources available for them, and the current regulatory climate affecting their practice.

The project culminated in a 64-page report that was disseminated to more than 3,500 governors, legislators, and policymakers throughout the South.

Key Results

  • The report concluded that nurse practitioners, certified nurse-midwives, and physician assistants can provide selected medical services equivalent to those provided by primary care physicians and at lower cost.

  • Southern states could improve the health care of women and children, particularly in rural areas if they made greater use of these practitioners.

    These health professionals, however, face a number of common barriers to practice in the South, including:

    • Poor public awareness about their training and scope of practice;
    • Exclusion from lists of health providers maintained by managed care companies;
    • Lower Medicaid reimbursement than that offered to physicians who provide the same services.


    In addition, nurse practitioners and certified nurse-midwives face organized opposition from physicians to their practice.

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