The Rise of the Nurse Practitioner: Telehealth's Best Kept Secret

The secret for telemedicine's future success may not be obvious, but it’s right in front of us.

It’s 10 PM. You’ve worked an entire day making patient rounds, reviewing clinical protocols, and attending administrative meetings. Now, finally home, you catch snippets of the evening news between longer and longer blinks, eyes heavy with fatigue. You yearn for sleep, but the anxiety of being the only on-call physician overwhelms you.

This is the reality for a 68-year-old family physician, Ed Garner, the solo-provider for a rural, 11,000 square-mile area in West Texas. And like Dr. Garner, so many other rural physicians and medical providers face the same exhausting, daunting responsibility.

Rural areas account for 20% of the population in the U.S., but less than 10% of physicians, leading the federal government to designate nearly 80% of rural America as “medically underserved.”

Nearly 80% of rural America are “medically underserved."

According to a 2018 report by the American Enterprise Institute (AEI), health care economist and professor of nursing at Montana State University, Peter Buerhaus, found that, despite decades of spending, tens of millions of Americans do not have adequate access to safe, high-quality primary care—particularly in rural areas.

And news and warnings about the silver tsunami and physician shortages—while warranted—are almost played out tropes at this point. As is reported in story after story, the care ratio is projected to grow in the coming years due to a declining number of primary care physicians and a growing elderly population that far exceeds the number of physicians available to treat them. And it's even more palpable than ever during the COVID-19 crisis.

Profiles of physicians like Ed Garner, poignantly demonstrate the challenges we face now and in years to come in healthcare delivery. But there is a solution. And it has nothing to do with AI, Amazon, or Apple. It’s not nearly as sexy as that.

That’s right. The results of this combo are substantially more powerful than each on their own. But surprisingly, the two together have often been overlooked.

Interestingly, the NP + telemedicine duo is not new. One of the earliest references to the use of telehealth involved a connected medical station staffed with nurse clinicians at Boston Logan International Airport and Massachusetts General Hospital in 1963.

Today, nurse practitioners are licensed in all 50 states and represent 250,000 solutions for improved patient access. In fact, 87% of NPs are certified in primary care. These providers could extend care even further when armed with telehealth technology.

By expanding patient access and alleviating physician shortages, NPs are perfectly positioned to diagnose, prescribe, and treat with telemedicine in a scalable manner.

Yet until recently, nurse practitioners were largely excluded from the telehealth movement. The majority of platforms providing telehealth services have been powered by physicians.

Why have NPs been on the sidelines?

Cumbersome state regulations restricting nurse practitioner scope of practice and the absence of interstate licensure add complexity and cost to engaging this ready, able, and willing sector of healthcare providers.

While 23 states have full practice authority (FPA), meaning that nurse practitioners can practice to the full extent of their training without any relationship with a physician, the remaining 27 states have restrictive regulations that require some degree of physician involvement. In states like Texas, California, and Florida, this often involves a contract or agreement with a physician that can cost the nurse practitioner upwards of several thousand dollars per month.

In addition to out-of-pocket costs, there are even geographic limitations. States like Georgia require NPs to practice within specific geographic boundaries of the supervising physician.

And it’s not only NPs that view these restrictions as burdensome. A Florida physician recently described some of these barriers in legislative hearings to remove restrictions to NP practice in Florida, and other doctors have been promoting the value of the NP online.

Though doctors and PAs are still critical and valuable to our healthcare system, empowering our NP workforce is a necessary next step in addressing major shortcomings in patient care-- particularly through telehealth.

What we can do.

At Wheel, we recognize the value of nurse practitioners and the critical role they will play in easing our nation’s healthcare shortage, providing cost-effective but high-quality care. That’s why we’ve invested the necessary legal and educational resources to engage nurse practitioners within our network as part of our collaborative telehealth care teams.

This approach has been a resounding success. It’s clear that the dynamic telehealth + NP duo is far sexier and more impactful than any new wearable or corporate telehealth collaboration.

But elevating our nurse practitioners is not a solo mission. We need your help, too!

If you value increased access to convenient, high quality, affordable healthcare, please let your legislators know that you support removing antiquated and unnecessary restrictions on nurse practitioner practice in your state.

Together, we hope that someday soon, telemedicine’s best-kept secret will become a familiar pairing.

- Veronica Pike, APRN, FNP

Interested in joining our telehealth nurse practitioner network? Sign up to explore telemedicine jobs for nurse practitioners with Wheel.