November 2004
Prepared for the Department of Health
and Human Services, Health Resources and
Services Administration, Bureau of Health
Professions, National Center for Health
Workforce Analysis: Purchase Order No.
01-0532(P)
Executive
Summary
In the fall of 2000, a survey of licensed
Nurse Practitioners (NPs) in New York
State was conducted under contract from
HRSA with the Center for Health Workforce
Studies at the University at Albany, State
University of New York. The study was
intended to produce a snapshot of New
York State NPs, with particular emphasis
on their educational background, practice
patterns, and perceptions of the job market.
This report contains a profile of these
characteristics for all NPs, as well as
an analysis of variation by age, graduation
cohort, specialty certification, and race/ethnicity.
A brief examination of the NPs who reported
independent solo or group practice is
also presented.
Major findings for the profession as
a whole are as follows:
Background
information
- Most NPs (76 percent)
worked exclusively as NPs, although
20 percent reported practicing as both
an NP and an RN.
- NPs were overwhelmingly female (94.5
percent).
- The majority of NPs were non-Hispanic
whites, although racial/ethnic diversity
has increased in recent cohorts. Almost
all NPs were U.S. citizens, with a small
number (1.5 percent) reporting themselves
to be permanent non-citizen residents.
- NPs were substantially older than
the civilian labor force as a whole,
with a median age of 45 versus 39 for
the civilian labor force. Their age
was comparable to that of registered
nurses in New York State in 2000, who
had a median age of 44 (BLS, 2000).
Education
- The education production
of NPs in New York State has increased
dramatically in recent years, with almost
52 percent of NPs graduating from their
NP program between 1995 and 1999. Only
22 percent of NPs graduated during the
previous five-year period (1990 to 1994),
and only 10 percent of NPs graduated
during the period of 1985 – 1989.
- Over 90 percent of NPs hold a master’s
degree, either alone or in conjunction
with an advanced certificate. Seventy-six
percent report that they are credentialed
by at least one national credentialing
association.
Current
NP practice
- One-third of NPs work
at least 40 hours a week as a NP, although
almost 10 percent work fewer than 10
hours a week as an NP.
- The majority of NPs (57 percent) work
only in patient care, with the remainder
of the NPs reporting at least some hours
of administration, teaching, or research.
The number of hours in these activities
is typically very small, however, with
patient care constituting the major
activity for the vast majority of NPs.
- NPs were most likely to have a certification
in family health (33 percent), adult
health (31 percent), pediatrics (14
percent), or psychiatry (6 percent).
Very small numbers of NPs specialized
in community health, perinatology, oncology,
or school health.
- Most NPs (70 percent) work at only
one practice site, another 23 percent
worked at two practice sites, and 8
percent reported working at three or
more sites.
- The type of care provided by NPs at
their principal practice site is about
equally likely to be primary care versus
specialty care.
- The most common principal practice
settings for NPs are: physician offices
at 31 percent (22 percent group and
9 percent solo practice); hospitals
at 30 percent (15 percent ambulatory
care, 11 percent inpatient care, 2.4
percent emergency rooms, and 1.8 percent
psychiatric hospitals); and NP practice
at 7 percent (5 percent group and 2
percent solo practices).
- Slightly more than one-third of NPs
work with a collaborating physician
whose specialty is family practice (13
percent), general internal medicine
(11 percent), or general pediatrics
(11 percent). An additional 12 percent
work with obstetricians/gynecologists.
The specialty certifications of NPs
tend to match the specialty of the collaborating
physician at their principal practice
setting.
- Few NPs report plans to retire, reduce
patient care hours, or change the location
of their practice in the next 12 months.
- The largest number of NPs (32 percent)
work in suburban areas, but almost as
many (31 percent) practice in an inner-city
area, while another 15 percent practice
in a rural area or small town. Sixty-seven
percent of rural NPs provide primary
care.
Scope
of practice and reimbursement/provider
status
- Over two-thirds of
NPs are Drug Enforcement Agency (DEA)
certified to prescribe controlled substances.
Only one-quarter have their own Medicaid
provider number and only about one-third
have a Medicare provider number.
- Ninety percent or more of NPs perform
histories and physical exams, order
laboratory tests, or make direct referrals
to specialists, although less than a
third provide on-call services and very
few (less than 5 percent) assist in
surgeries.
- Almost half of NPs collaborate daily
with their designated collaborating
physician, and almost one-third report
weekly collaboration. Ten percent report
collaborating monthly, while 12 percent
only do so as required by law (every
3 months).
Impression
of the job market for NPs
- Most NPs in 2000 (54
percent) reported that they did not
have a difficult time finding a satisfactory
position, and only 10 percent felt that
there were no job openings for NPs overall,
but the setting-specific evaluations
tended to be more negative. The number
of NPs that reported no job openings
in specific settings ranged from 18
percent in physician offices to 48 percent
in home health agencies.
Introduction
Nurse practitioners (NPs) are registered
nurses (RNs) with advanced academic and
clinical experience. They may provide
a range of health care services, including
health maintenance, disease prevention,
counseling, assessment, and management
of acute or chronic illness. NPs are
growing in importance as health care providers
as they grow in number and as preparation
becomes available in a greater variety
of specialties.
The number of trained NPs in the United
States has increased substantially over
the course of the past decade, growing
more than 240 percent between 1992 and
2000 (USDHHS, 2000). The number of annual
NP graduates nationwide more than tripled
between 1994 and 1998, and despite a slight
decline in 1999 and 2000, the number of
annual graduates remains at a much higher
level than in 1990 (Wing et al., 2003).
NP specialty preparation is generally
available in neonatology, obstetrics/gynecology,
pediatrics, school health, family health,
adult health, women’s health, psychiatry,
geriatrics, and acute care, and other
specialties are available in certain States.
In New York State in 2000, NP specialties
included all of the above, plus a small
number of NPs with specializations in
community health, perinatology, and oncology.
NPs are a potentially important source
of health care. Yet, we still know relatively
little about how NPs are used in the health
care system, especially in terms of their
role as extensions or supplements to physician
care. There have been some indications
that the scope of practice for NPs has
expanded in the past several years (Wing
et al., 2003). There have also been some
indications that they are no longer predominantly
primary care providers, but are increasingly
providing some specialty services. Both
of these developments would increase the
importance of NPs as sources of cost-effective
health care.
New York State is one of the most populous
States in the Nation, and has the second
largest number of NPs of any State in
the Nation. New York State ranks 10th
in the Nation in NPs per capita. It is
also a diverse State racially, ethnically,
and geographically. The current study
examines licensed NPs in New York State
in terms of their educational background,
practice patterns, and perceptions of
the job market. While not nationally
representative, the responses of these
New York State NPs are valuable information
that may tell us a great deal about the
role of NPs in the health care system
nationwide.
Overview
of Survey
In the fall of 2000 a survey of all licensed
NPs in New York State was conducted under
contract from HRSA with the Center for
Health Workforce Studies at the University
at Albany, State University of New York.
The study was intended to produce a snapshot
of New York State NPs, with particular
emphasis on their educational background,
practice patterns, and perceptions of
the job market. A short survey asking
only limited, basic questions was mailed
to 75 percent of licensed NPs (6,157),
while a detailed survey was mailed to
the other 25 percent of NPs (1,724).
Both surveys are presented in Appendix
A.
In March 2000, a list of all 9,019
NPs certified in the State was provided
to the Center by the New York State Education
Department (SED) for the purposes of the
survey. A careful review of the list revealed
that 453 of the names were duplicates;
that is 453 NPs were listed more than
once because they were certified in more
than one specialty. That left a total
of 8,638 individuals with NP certificates.
The review of the NP file also revealed
that 430 NPs lived in states that were
not contiguous to New York. These NPs
also were excluded from the survey. This
left 8,208 NPs to be surveyed beginning
in spring of 2000. A 25 percent sample
of NPs was randomly drawn from each certified
specialty with the exception of geriatric
and mental health NPs who were intentionally
over-sampled. This was done to permit
an in-depth analysis of these specialties
using the “long” survey form.
Because there are only several hundred
NPs in each of these specialties, it was
determined that a 25 percent sample would
not provide a sufficiently large base
for a specialty-specific analysis. (Other
specialty areas, such as family health,
pediatrics and adult health were sufficiently
large to permit a specialty-specific analysis
without over-sampling.)
In June 2000, 8,208 surveys were mailed
to all NPs certified in New York and residing
in New York or adjacent States. A second
mailing was distributed to the non-respondents
in September; and a third mailing was
distributed in November. Based on the
mailings and returns, it was determined
that 52 NPs listed in the SED file had
moved to a non-neighboring State and that
3 were deceased at the time of the survey.
In addition, 272 NPs had moved and not
left a forwarding address. Since one of
the requirements for licensure is to notify
the Education Department of a change in
address, these NPs also were excluded
from the analysis. This left a file of
7,881 NPs with an active RN license
and certified to work as an NP in the
State. 5,989 surveys were received,
for a total response rate of 76 percent.
1,319 long form surveys were returned,
or a 77 percent response rate, and 4,670
short form surveys were returned, or a
76 percent response rate.
Summary of Survey
Responses[1]
Description of NPs
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